Safety and efficacy of locoregional therapy for metastatic pancreatic ductal adenocarcinoma to the liver: A single-center experience

Ryan Earl Bailey, Phani Keerthi Surapaneni, Jacob Core, Lucas Lauar Cortizo Vidal, Jordan LeGout, Charles Ritchie, Gregory Frey, J. Mark McKinney, David Sella, Ricardo Paz-Fumagalli, Beau Toskich, Kabir Mody

Research output: Contribution to journalArticle

Abstract

Background: Many patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed with liver metastatic disease (mPDAC), and few are surgical candidates. Interventional oncology (IO) locoregional therapies (LRT) have proven beneficial in other primary and metastatic hepatic malignancies. Systemic chemotherapy is the standard of care for patients with mPDAC. This study assessed the safety and efficacy of LRT including thermal ablation, chemoembolization, and radioembolization for mPDAC. Methods: A retrospective analysis was performed of 28 patients with mPDAC referred to IR clinic for consideration of LRT from 01/2006 to 08/2017, of whom 20 underwent treatment. Laboratory values were analyzed at 0, 3, and 6 months post-treatment. Imaging response was evaluated at 1, 3, and 6 months post-intervention by modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Adverse events (AE) were classified by CTCAE v5.0. Overall survival (OS) from the diagnosis of PDAC, survival from the time of mPDAC diagnosis, and survival from the time of LRT were calculated. Results: Median OS (mOS) was 25 months. Median survival from time of mPDAC diagnosis and post LRT were 16.25 and 9.7 months, respectively. At one month post-intervention, 12 of 17 patients demonstrated disease response (CR or PR per mRECIST). Survival among responders was 9 months vs. 6 months for patients with stable or progressive disease (P=0.08). There were two grade 3 AE which included post-embolization syndrome and transient renal failure. Chemotherapy was briefly delayed in one of these patients, but ultimately resumed. Conclusions: The use of LRT in patients with mPDAC is safe. Additionally, no significant chemotherapy limiting toxicities were observed. Responders to therapy demonstrated a survival benefit trend in this small and heterogeneous cohort. Further investigations with randomized trials are warranted.

Original languageEnglish (US)
Pages (from-to)688-694
Number of pages7
JournalJournal of Gastrointestinal Oncology
Volume10
Issue number4
DOIs
StatePublished - Jan 1 2019

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Adenocarcinoma
Safety
Liver
Survival
Therapeutics
Drug Therapy
Standard of Care
Renal Insufficiency
Liver Diseases
Hot Temperature
Neoplasms

Keywords

  • Chemoembolization
  • Interventional
  • Metastatic pancreatic
  • Pancreatic adenocarcinoma
  • Pancreaticoduodenectomy (PDX)

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Safety and efficacy of locoregional therapy for metastatic pancreatic ductal adenocarcinoma to the liver : A single-center experience. / Bailey, Ryan Earl; Surapaneni, Phani Keerthi; Core, Jacob; Cortizo Vidal, Lucas Lauar; LeGout, Jordan; Ritchie, Charles; Frey, Gregory; McKinney, J. Mark; Sella, David; Paz-Fumagalli, Ricardo; Toskich, Beau; Mody, Kabir.

In: Journal of Gastrointestinal Oncology, Vol. 10, No. 4, 01.01.2019, p. 688-694.

Research output: Contribution to journalArticle

Bailey, RE, Surapaneni, PK, Core, J, Cortizo Vidal, LL, LeGout, J, Ritchie, C, Frey, G, McKinney, JM, Sella, D, Paz-Fumagalli, R, Toskich, B & Mody, K 2019, 'Safety and efficacy of locoregional therapy for metastatic pancreatic ductal adenocarcinoma to the liver: A single-center experience', Journal of Gastrointestinal Oncology, vol. 10, no. 4, pp. 688-694. https://doi.org/10.21037/jgo.2019.03.13
Bailey, Ryan Earl ; Surapaneni, Phani Keerthi ; Core, Jacob ; Cortizo Vidal, Lucas Lauar ; LeGout, Jordan ; Ritchie, Charles ; Frey, Gregory ; McKinney, J. Mark ; Sella, David ; Paz-Fumagalli, Ricardo ; Toskich, Beau ; Mody, Kabir. / Safety and efficacy of locoregional therapy for metastatic pancreatic ductal adenocarcinoma to the liver : A single-center experience. In: Journal of Gastrointestinal Oncology. 2019 ; Vol. 10, No. 4. pp. 688-694.
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abstract = "Background: Many patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed with liver metastatic disease (mPDAC), and few are surgical candidates. Interventional oncology (IO) locoregional therapies (LRT) have proven beneficial in other primary and metastatic hepatic malignancies. Systemic chemotherapy is the standard of care for patients with mPDAC. This study assessed the safety and efficacy of LRT including thermal ablation, chemoembolization, and radioembolization for mPDAC. Methods: A retrospective analysis was performed of 28 patients with mPDAC referred to IR clinic for consideration of LRT from 01/2006 to 08/2017, of whom 20 underwent treatment. Laboratory values were analyzed at 0, 3, and 6 months post-treatment. Imaging response was evaluated at 1, 3, and 6 months post-intervention by modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Adverse events (AE) were classified by CTCAE v5.0. Overall survival (OS) from the diagnosis of PDAC, survival from the time of mPDAC diagnosis, and survival from the time of LRT were calculated. Results: Median OS (mOS) was 25 months. Median survival from time of mPDAC diagnosis and post LRT were 16.25 and 9.7 months, respectively. At one month post-intervention, 12 of 17 patients demonstrated disease response (CR or PR per mRECIST). Survival among responders was 9 months vs. 6 months for patients with stable or progressive disease (P=0.08). There were two grade 3 AE which included post-embolization syndrome and transient renal failure. Chemotherapy was briefly delayed in one of these patients, but ultimately resumed. Conclusions: The use of LRT in patients with mPDAC is safe. Additionally, no significant chemotherapy limiting toxicities were observed. Responders to therapy demonstrated a survival benefit trend in this small and heterogeneous cohort. Further investigations with randomized trials are warranted.",
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T1 - Safety and efficacy of locoregional therapy for metastatic pancreatic ductal adenocarcinoma to the liver

T2 - A single-center experience

AU - Bailey, Ryan Earl

AU - Surapaneni, Phani Keerthi

AU - Core, Jacob

AU - Cortizo Vidal, Lucas Lauar

AU - LeGout, Jordan

AU - Ritchie, Charles

AU - Frey, Gregory

AU - McKinney, J. Mark

AU - Sella, David

AU - Paz-Fumagalli, Ricardo

AU - Toskich, Beau

AU - Mody, Kabir

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Many patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed with liver metastatic disease (mPDAC), and few are surgical candidates. Interventional oncology (IO) locoregional therapies (LRT) have proven beneficial in other primary and metastatic hepatic malignancies. Systemic chemotherapy is the standard of care for patients with mPDAC. This study assessed the safety and efficacy of LRT including thermal ablation, chemoembolization, and radioembolization for mPDAC. Methods: A retrospective analysis was performed of 28 patients with mPDAC referred to IR clinic for consideration of LRT from 01/2006 to 08/2017, of whom 20 underwent treatment. Laboratory values were analyzed at 0, 3, and 6 months post-treatment. Imaging response was evaluated at 1, 3, and 6 months post-intervention by modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Adverse events (AE) were classified by CTCAE v5.0. Overall survival (OS) from the diagnosis of PDAC, survival from the time of mPDAC diagnosis, and survival from the time of LRT were calculated. Results: Median OS (mOS) was 25 months. Median survival from time of mPDAC diagnosis and post LRT were 16.25 and 9.7 months, respectively. At one month post-intervention, 12 of 17 patients demonstrated disease response (CR or PR per mRECIST). Survival among responders was 9 months vs. 6 months for patients with stable or progressive disease (P=0.08). There were two grade 3 AE which included post-embolization syndrome and transient renal failure. Chemotherapy was briefly delayed in one of these patients, but ultimately resumed. Conclusions: The use of LRT in patients with mPDAC is safe. Additionally, no significant chemotherapy limiting toxicities were observed. Responders to therapy demonstrated a survival benefit trend in this small and heterogeneous cohort. Further investigations with randomized trials are warranted.

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KW - Chemoembolization

KW - Interventional

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KW - Pancreatic adenocarcinoma

KW - Pancreaticoduodenectomy (PDX)

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