In a study reported in the Journal of Clinical Oncology, Hendifar et al found that a computational histology artificial intelligence (CHAI)-powered platform could be used to identify whether gemcitabine-based (G-chemo) or fluoropyrimidine-based (F-chemo) chemotherapy is preferred as first-line treatment in advanced pancreatic ductal adenocarcinoma.
Study Details
In the multinational study, the CHAI platform extracted quantitative histomorphologic features from diagnostic biopsies. In a development cohort of 178 patients, features associated with differential outcomes measured by time to next treatment or death (TNTD) between F-chemo–treated and G-chemo–treated patients were used to develop continuous biomarker scores that were dichotomized into G-pref (favoring G-chemo) or F-pref (favoring F-chemo) results (GvF biomarker). The main outcomes of interest were TNTD and overall survival according to receipt of G-chemo or F-chemo among G-pref and F-pref patients.
Key Findings
Among 299 patients in the validation cohort, there were 126 G-pref patients and 173 F-pref patients. Among G-pref patients, 43 received G-chemo; among F-pref patients, 113 received F-chemo.
Among G-pref patients, the G-chemo group had significantly better TNTD vs the F-chemo group (median = 9.6 vs 7.2 months, P = .038), with no significant benefit in overall survival observed (median = 14.3 vs 12.4 months, P = .52).
Among F-pref patients, the F-chemo group had significantly better TNTD (median = 8.6 vs 7.5 months, P = .035) and significantly better overall survival (median = 14.4 vs 11.7 months, P = .003) vs the G-chemo group.
In propensity score–weighted analysis, the GvF biomarker predicted the treatment effect (biomarker-treatment interaction: TNTD = P < .001, overall survival = P = .005).
The investigators concluded: “The histomorphology-based GvF biomarker predicted differential treatment benefit of first-line GvF. This biomarker can guide optimal treatment selection for first-line therapy in advanced PDAC.”
Viswesh Krishna, BS, of Valar Labs, Inc., Palo Alto, California, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by the Pancreatic Cancer Action Network (PanCAN–Know Your Tumor), University Health Network, Toronto, and Valar Labs, Inc. For full disclosures of the study authors, visit ascopubs.org.
