Keepin’ it real.

Top Line: Survival after a diagnosis of borderline resectable or locally-advanced pancreatic cancer has seen some forward leaps in recent years with reimagined chemotherapy and radiation techniques.

The Study: At least that’s the story of headlining pubs. Here’s what we’d call a practical phase 4 study of how neoadjuvant chemo +/- radiation plays out in the real world. Or at least in real Italia. The goal was to "investigate pragmatically” the compliance and impact of upfront chemo, mostly FOLFIRINOX (46%) and gem / Abraxane (22%), prospectively among 680 patients within a single Italian hospital system. Importantly, nearly three-quarters of patients successfully completed their planned chemo. Roughly a quarter of borderline resectable and 10% of locally-advanced cases proceeded to surgery. What were the independent predictors of longer survival? Resection (HR 0.2) and completion of chemo (HR 0.4), particularly FOLFIRINOX—granted those are basic surrogates for disease response and medical fitness, respectively. What else significantly prolonged survival? “Complementary” radiation (HR 0.7).

TBL: A real world unselected population confirms the survival advantages of FOLFIRINOX and modern radiation for borderline resectable or locally-advanced pancreatic cancer. | Maggino, JAMA Surg 2019