Chemoimmunotherapy Improves Outcome in Stage 3 Pancreatic Cancer

Laurie Barclay, MD

December 19, 2002

Dec. 19, 2002 — Locoregional chemoimmunotherapy signficantly improved outcomes for patients with stage 3 pancreatic cancer, according to the results of a prospective randomized study reported in the December issue of the Annals of Surgery.

"Surgical resection remains the gold standard for the management of pancreatic cancer," write Nikolaos J. Lygidakis, MD, FACS, from Athens Medical Center in Greece, and colleagues. "However, despite impressive improvements on early results concerning hospital mortality and morbidity, long-term results regarding overall survival remain disappointingly poor, particularly for patients with stage 3 disease who are undergoing surgical resection."

Of 128 patients with stage 3 pancreatic duct cancer who underwent pancreatic resection between November 1993 and October 2000, 40 (group A) had no adjuvant therapy; 45 (group B) received adjuvant locoregional chemotherapy; and 43 (group C) received adjuvant locoregional chemoimmunotherapy. Adjuvant therapy in groups B and C was administered into the superior mesenteric artery using an arterial catheter advanced under fluoroscopic control into a side arterial branch of the jejunal artery.

Two- and five-year survival was 65% and 18%, respectively, for the chemoimmunotherapy group, compared with 29% and 0% for surgery alone and 52% and 10% for surgery and chemotherapy but not immunotherapy.

Disease-free survival at two and five years were 20% and 0% for group A, 35% and 7% for group B, and 58% and 11% for group C, respectively. Statistical differences among groups beginning in the second and third years led to early termination of the study for ethical reasons.

"When applied regionally, combined chemoimmunotherapy is simple, safe, and effective," the authors write. "This type of therapy offers substantial advantages in terms of prolonging overall survival and improving disease-free survival compared to surgical resection alone or to surgical resection and adjuvant regional chemotherapy."

Ann Surg. 2002;236(6):806-813

Reviewed by Gary D. Vogin, MD


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