2018 ASCO: PREOPANC-1 Trial Compares Preoperative Chemoradiotherapy vs Immediate Surgery for Pancreatic Cancer

Key Points

  • The median overall survival was 17.1 months with preoperative chemoradiotherapy compared to 13.7 months with immediate surgery.
  • The time until pancreatic cancer recurrence was longer with preoperative therapy (9.9 vs 7.9 months).
  • The chance of surviving longer than 2 years was higher with preoperative treatment than with immediate surgery (42% vs 30%).
  • Among patients in whom the tumor was surgically removed successfully, the difference in median survival was even greater: 42.1 months with preoperative treatment vs 16.8 months with immediate surgery.  

A randomized, phase III trial found that patients who received chemoradiotherapy before pancreatic cancer surgery had better disease-free survival than those who started their treatment with surgery, which is the current standard of care. In addition, the 2-year survival rate was higher for those who received chemoradiotherapy before surgery (42% vs 30%). The preliminary findings of this trial show that chemoradiotherapy before surgery may be beneficial for patients with pancreatic cancer. 

The study was featured in a press briefing today and presented by Van Tienhoven et al at the 2018 ASCO Annual Meeting (Abstract LBA4002).

“This is the first randomized clinical trial to show that preoperative treatment improves outcomes for people with [early-stage] … pancreatic cancer who can have surgery,” said principal investigator Geertjan Van Tienhoven, MD, PhD, a radiation oncologist in the Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands. “We believe that this may be a practice-changing trial.”

About the Study

The PREOPANC-1 trial enrolled 246 patients with pancreatic cancer that could be surgically removed. The patients were randomly assigned to receive immediate surgery or chemoradiotherapy for 10 weeks followed by surgery. Both treatment groups also received chemotherapy after surgery, and the total amount of chemotherapy given was equal in both groups (the chemoradiotherapy group received part of the chemotherapy before surgery and the rest after).

Key Findings

The median overall survival was 17.1 months with preoperative chemoradiotherapy compared to 13.7 months (P = .74) with immediate surgery. The time until pancreatic cancer recurrence was longer with preoperative therapy (9.9 vs 7.9 months, P = .023). The chance of surviving longer than 2 years was also higher with preoperative treatment than with immediate surgery (42% vs 30%). Among patients in whom the tumor was surgically removed successfully, the difference in median survival was even greater: 42.1 months with preoperative treatment vs 16.8 months with immediate surgery.  

Resection was performed in 72% of patients in the immediate-surgery group and 62% in the chemoradiotherapy group. Among patients who had a resection, the tumor was microscopically completely removed in a greater proportion of patients who received preoperative treatment (63% vs 31%).

Next Steps

According to the authors, after the final analysis and publication of this trial, the next step is to attempt to find even more effective preoperative treatments. FOLFIRINOX chemotherapy or FOLFIRINOX combined with stereotactic body radiation therapy appear promising from other studies and should be tested against preoperative gemcitabine and radiation in a randomized clinical trial. 

This study received funding from the Dutch Cancer Society KWF.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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