Time to Neoadjuvant Chemotherapy Initiation Is not Associated With Survival in Pancreatic Cancer.

Abstract

Not all patients with pancreatic adenocarcinoma (PDAC) tolerate multiagent neoadjuvant chemotherapy (NAC). We utilized institutional data and the National Cancer Database (NCDB) to investigate if time from diagnosis to NAC initiation is associated with survival. Patients who received NAC and underwent pancreatectomy at our institution (2010-2021) or within the NCDB (2010-2016) were identified. Time from diagnosis to NAC was grouped: <21, 21-35, and >35d. Recurrence-free (RFS) and overall survival (OS) was compared. At our institution, 122 patients received NAC before pancreatectomy (<21 d: n=36; 21-35 d: n=61; >35 d: n=25). Demographics, performance status, and anatomic resectability were similar. There was no difference in RFS (13.3 versus 12.4 versus 11.9mo) or OS (26.7 versus 25.8 versus 26.1mo) based on NAC timing. Patients who received FOLFIRINOX had an improvement in RFS (14.4 versus 12.2 versus 6.8mo, P=0.05) and OS (39.2 versus 21.4 versus 17.3mo, P=0.01) compared to gemcitabine with nab-paclitaxel or other regimens. Within the NCDB, 6713 patients were included (<21 d: n=2087; 21-35 d: n=2656; >35 d: n=1970). There was no difference in OS (21.6 versus 20.9 versus 22.2mo). Multiagent NAC was associated with improved OS compared to single-agent (22.6 versus 18.8mo, P<0.001). Delay in NAC initiation for PDAC is not associated with survival. Patient optimization could be considered with the goal of improving tolerance of multiagent chemotherapy.