Liver-directed therapy (LDT) and systemic chemotherapy for pancreatic adenocarcinoma with liver metastases (PCLM): Experience of 12 years.

Abstract

e16768 Background: PCLM has a poor prognosis with a median survival of ≤6 months. Treatment options are limited as only few patients can undergo curative surgery, therefore locoregional therapies such as LDT offer an adjunct to systemic therapies. Combination of LDT and systemic therapies is a strategy to enhance the effect of radioembolization or chemotherapy alone, akin to the use of radiotherapy with chemotherapy. The purpose of this retrospective study was to evaluate the efficacy of incorporating trans-arterial radioembolization (TARE) with 90Y, trans-arterial chemoembolization (TACE), and radiofrequency ablation (RFA) with systemic chemotherapy in the treatment of PCLM. Methods: We retrospectively evaluated 42 patients, with data available on 39 patients, with PCLM who underwent LDT between February 2007 and March 2019. Patient outcomes were assessed using Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1 including disease response, median overall survival (mOS) from the time of diagnosis of metastatic disease, and mOS following receipt of LDT. Treatment-related adverse events were assessed using Common Terminology Criteria for Adverse Events (CTACE), Version 5.0. Results: Of 39 patients, 56% underwent TARE, 36% RFA, and 7.8% TACE. The selection of modality was based on institutional standards and at the discretion of the referring physician. The mOS was 5 months (range 4-5.5 months) from the application of LDT and the one-year mOS was 7.8 months (6.5-9.5 months). Overall and liver specific disease response assessed with follow-up imaging (range 4-12 weeks post therapy) was complete response in 2.5%, partial response in 59%, stable disease in 21%, and progression of disease in 18% of patients. The mean interval between the diagnosis and initial LDT was 6 months. All patients received single course of TARE for each diseased liver lobe. In 26% of patients who had bilobar liver disease, the combination treatments for both diseased lobes was defined a single course. The mean Y90 radiation dose delivered to the right lobe was 1.00 GBq and to the left lobe was 0.64 Gbq. Grade 3 toxicities included abdominal pain in 13%, hyperbilirubinemia in 7.7%, fever in 7.7%, abscess in 2.6%, and thrombocytopenia in 5.1% of patients. No treatment-related grade 4 or 5 toxicities were seen. Conclusions: LDT can be safely combined with systemic chemotherapy for the treatment of PCLM. Patient outcomes following this treatment strategy are promising but prospective evaluations are needed to validate these preliminary findings.