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Timing of Adjuvant Systemic Therapy and Survival for Pancreatic Cancer
Anays Murillo
*, Gordana Rasic, Sarah M. Schroter, Sing Chau Ng, Kelly Kenzik, Teviah E. Sachs
Boston Medical Center, Brookline, MA
Background. Optimal timing of adjuvant therapy (AT) initiation after pancreatic carcinoma (PC) resection has not been established. While the National Comprehensive Cancer Network recommends providing therapy within 12 weeks of surgery, several clinical trials and the American Society of Clinical Oncology have used timeframes closer to 8 weeks. We compared outcomes and predictors of AT within 8 weeks versus 8 to 12 weeks of surgery.
Study Design. The National Cancer Database was queried for patients diagnosed with clinical stages I-III PC (2010-2021) who underwent definitive resection followed by AT at 0-8 weeks (early AT) or 8-12 weeks (later AT). Neoadjuvant therapy patients were excluded. We identified predictors for later AT with multivariable logistic regression. Propensity score matching was performed, and survival was compared via Kaplan-Meier analysis.
Results. There were 5,621 (64%) patients with early AT and 3,190 (36%) with later AT. Patients who were over 66, Black, other than white race, Medicaid/other government/uninsured, and who underwent open surgery were significantly more likely to receive later AT (OR 1.28, 95% CI: 1.14-1.44, p<0.0001; 1.46, 1.27-1.67, p<0.0001; 1.40, 1.13-1.73, p=0.0022; 1.32, 1.12-1.55, p=0.0008; 1.19, 1.06-1.32, p=0.0020; respectively) (Figure 1). Both community and integrated cancer centers were associated with early AT as compared to academic centers (OR 0.80, 95% CI: 0.72-0.89, p<0.0001; 0.87, 0.77-0.98, p=0.0200; respectively) (Figure 1). After matching (n=3,190), overall 5 year survival (26.3% vs 23.8%) and median survival (28.4 months vs 26.4 months) was greater for early AT patients (p=0.0188) (Figure 2).
Conclusions. Early AT showed improved median and overall survival. Several factors including age, race and insurance status, were associated with later initiation of treatment. For patients not undergoing neoadjuvant therapy, early AT may be of benefit.
