Abstract
BackgroundIrreversible electroporation (IRE) has emerged as a viable consolidative therapy after induction chemotherapy, in which this combination has improved overall survival of locally advanced pancreatic cancer (LAPC). Optimal timing and patient selection for irreversible electroporation remains a clinically unmet need. The aim of this study was to investigate preoperative factors that may assist in predicting progression-free and overall survival following IRE.MethodsA multi-institutional, prospectively maintained database was reviewed for patients with LAPC treated with induction chemotherapy followed by open-technique irreversible electroporation from 7/2015-5/2019. RECIST 1.1 criteria were used to assess tumor response and radiological progression. Overall survival (OS) and progression-free survival (PFS) were recorded. Survival analyses were performed using Kaplan Meier and Cox multivariable regression analyses.Results187 LAPC patients (median age 62 years range, 21 – 91, 65% men, 35% women) were treated with IRE. Median PFS was 21.7 months and median OS from diagnosis was 25.5 months. On multivariable analysis, age ≤ 61 (HR 0.41, 95%CI 0.21-0.78, p<0.008) and no prior radiation (HR 0.49, 95%CI 0.26-0.94, p=0.03) were positive predictors of OS after IRE. Age ≤ 61(HR 0.53, 95%CI, 0.28-.99, p=0.046) and FOLFIRINOX followed by gemcitabine/abraxane induction chemotherapy (HR 0.37,95%CI 0.15-0.89, p=0.027) predicted prolonged PFS after IRE. Abnormal CA19-9 values at the time of surgery negatively impacted both OS (HR 2.46, 95%CI 1.28-4.72, p<0.007) and PFS (HR 2.192, 95%CI 1.143-4.201, p=0.018) following IRE.ConclusionsAge, CA 19-9 response, avoidance of pre-IRE radiation, and FOLFIRINOX plus gemcitabine/abraxane induction chemotherapy are prominent factors to consider when referring or selecting LAPC patients to undergo IRE.
Highlights
The diagnosis of pancreatic ductal adenocarcinoma (PDAC) continues to have a challenging prognosis, but improvements in multi-disciplinary care have raised the overall survival rates to 10% for all stages [1]
Modern systemic chemotherapy followed by surgical resection has dramatically improved the standard of care, this is only available to approximately 10-20% of the patients diagnosed each year
This prospective pancreatic cancer registry represents a multi-institutional collection of patients with radiographic stage III locally advanced pancreatic cancer (LAPC) all of whom were treated with Irreversible electroporation (IRE) [13]
Summary
The diagnosis of pancreatic ductal adenocarcinoma (PDAC) continues to have a challenging prognosis, but improvements in multi-disciplinary care have raised the overall survival rates to 10% for all stages [1]. Forty percent of patients present with local invasion [stage III locally advanced pancreatic cancer (LAPC)] and are most often prescribed poorly responsive systemic palliative chemotherapy [3]. A current clinical unmet need is to develop and offer clinically effective therapies to consolidate the response of systemic chemotherapy in patients with unresectable LAPC after 3-4 months of induction therapy. Irreversible electroporation (IRE) has emerged as a viable consolidative therapy after induction chemotherapy, in which this combination has improved overall survival of locally advanced pancreatic cancer (LAPC).
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