Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy
Abstract Purpose/Objectives Most patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC. Materials/Methods Pat...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6582 |
| _version_ | 1797277110223503360 |
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| author | Saryleine deOrtiz de Choudens Alexis Visotcky Anjishnu Banerjee Mohammed Aldakkak Susan Tsai Douglas B. Evans Kathleen K. Christians Callisia N. Clarke Ben George Aditya Shreenivas Mandana Kamgar Sakti Chakrabarti Kulwinder S. Dua Abdul Haq Khan Srivats Madhavan Beth A. Erickson William A. Hall |
| author_facet | Saryleine deOrtiz de Choudens Alexis Visotcky Anjishnu Banerjee Mohammed Aldakkak Susan Tsai Douglas B. Evans Kathleen K. Christians Callisia N. Clarke Ben George Aditya Shreenivas Mandana Kamgar Sakti Chakrabarti Kulwinder S. Dua Abdul Haq Khan Srivats Madhavan Beth A. Erickson William A. Hall |
| author_sort | Saryleine deOrtiz de Choudens |
| collection | DOAJ |
| description | Abstract Purpose/Objectives Most patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC. Materials/Methods Patients presenting with metastatic PDAC that received treatment at our institution with FOLFIRINOX or gemcitabine‐based chemotherapies between August 1, 2011 and September 1, 2017 were included in the study. Metastatic disease burden was comprehensively characterized radiologically via individual diagnostic imaging segmentation. Landmark analysis was performed at 18 months, and survival curves were estimated using the Kaplan–Meier method and compared between groups via the log‐rank test. ECOG and Charlson Comorbidity Index (CCI) were calculated for all patients. Results 121 patients were included with a median age of 62 years (37–86), 40% were female, 25% had ECOG 0 at presentation. Of the 121 patients included, 33% (n = 41) were alive at 12 months and 25% (n = 31) were alive at 18 months. Landmark analysis demonstrated a significant difference between patients surviving <18 months and ≥18 months regarding the presence of lung only metastases (36% vs. 16%, p = 0.04), number of organs with metastases (≥2 vs. 1, p = 0.04), and disease volume (mean of 19.1 cc vs. 1.4 cc, p = 0.04). At Year 1, predictors for improved OS included ECOG status at diagnosis (ECOG 0 vs. ECOG 1, p = 0.04), metastatic disease volume at diagnosis (≤0.1 cc vs. >60 cc, p = 0.004), metastasis only in the liver (p = 0.04), and normalization of CA 19‐9 (p < 0.001). At Year 2, the only predictor of improved OS was normalization of the CA 19‐9 (p = 0.03). In those patients that normalized their CA 19‐9, median overall survival was 16 months. Conclusions In this exploratory analysis normalization of CA‐19‐9 or volumetric metastatic disease burden less than 0.2 cc demonstrated a remarkable OS, similar to that of patients with non‐metastatic disease. These metrics are useful for counseling patients and identifying cohorts that may be optimal for trials exploring metastatic and/or local tumor‐directed interventions. |
| first_indexed | 2024-03-07T15:43:59Z |
| format | Article |
| id | doaj.art-d0a3e59b182b4d1c8f7d23ee7bc3a49f |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-07T15:43:59Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-d0a3e59b182b4d1c8f7d23ee7bc3a49f2024-03-05T06:22:52ZengWileyCancer Medicine2045-76342024-01-01131n/an/a10.1002/cam4.6582Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapySaryleine deOrtiz de Choudens0Alexis Visotcky1Anjishnu Banerjee2Mohammed Aldakkak3Susan Tsai4Douglas B. Evans5Kathleen K. Christians6Callisia N. Clarke7Ben George8Aditya Shreenivas9Mandana Kamgar10Sakti Chakrabarti11Kulwinder S. Dua12Abdul Haq Khan13Srivats Madhavan14Beth A. Erickson15William A. Hall16Department of Radiation Oncology Medical College of Wisconsin Milwaukee Wisconsin USADivision of Biostatistics Medical College of Wisconsin Milwaukee Wisconsin USADivision of Biostatistics Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Surgery Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Surgery Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Surgery Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Surgery Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Surgery Medical College of Wisconsin Milwaukee Wisconsin USALaBahn Pancreatic Cancer Program Milwaukee Wisconsin USADivision of Medical Oncology Medical College of Wisconsin Milwaukee Wisconsin USALaBahn Pancreatic Cancer Program Milwaukee Wisconsin USADivision of Medical Oncology Medical College of Wisconsin Milwaukee Wisconsin USADivision of Medical Oncology Medical College of Wisconsin Milwaukee Wisconsin USADivision of Medical Oncology Medical College of Wisconsin Milwaukee Wisconsin USADivision of Medical Oncology Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Radiation Oncology Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Radiation Oncology Medical College of Wisconsin Milwaukee Wisconsin USAAbstract Purpose/Objectives Most patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC. Materials/Methods Patients presenting with metastatic PDAC that received treatment at our institution with FOLFIRINOX or gemcitabine‐based chemotherapies between August 1, 2011 and September 1, 2017 were included in the study. Metastatic disease burden was comprehensively characterized radiologically via individual diagnostic imaging segmentation. Landmark analysis was performed at 18 months, and survival curves were estimated using the Kaplan–Meier method and compared between groups via the log‐rank test. ECOG and Charlson Comorbidity Index (CCI) were calculated for all patients. Results 121 patients were included with a median age of 62 years (37–86), 40% were female, 25% had ECOG 0 at presentation. Of the 121 patients included, 33% (n = 41) were alive at 12 months and 25% (n = 31) were alive at 18 months. Landmark analysis demonstrated a significant difference between patients surviving <18 months and ≥18 months regarding the presence of lung only metastases (36% vs. 16%, p = 0.04), number of organs with metastases (≥2 vs. 1, p = 0.04), and disease volume (mean of 19.1 cc vs. 1.4 cc, p = 0.04). At Year 1, predictors for improved OS included ECOG status at diagnosis (ECOG 0 vs. ECOG 1, p = 0.04), metastatic disease volume at diagnosis (≤0.1 cc vs. >60 cc, p = 0.004), metastasis only in the liver (p = 0.04), and normalization of CA 19‐9 (p < 0.001). At Year 2, the only predictor of improved OS was normalization of the CA 19‐9 (p = 0.03). In those patients that normalized their CA 19‐9, median overall survival was 16 months. Conclusions In this exploratory analysis normalization of CA‐19‐9 or volumetric metastatic disease burden less than 0.2 cc demonstrated a remarkable OS, similar to that of patients with non‐metastatic disease. These metrics are useful for counseling patients and identifying cohorts that may be optimal for trials exploring metastatic and/or local tumor‐directed interventions.https://doi.org/10.1002/cam4.6582neoplasm metastasisoligometastasispancreatic neoplasms |
| spellingShingle | Saryleine deOrtiz de Choudens Alexis Visotcky Anjishnu Banerjee Mohammed Aldakkak Susan Tsai Douglas B. Evans Kathleen K. Christians Callisia N. Clarke Ben George Aditya Shreenivas Mandana Kamgar Sakti Chakrabarti Kulwinder S. Dua Abdul Haq Khan Srivats Madhavan Beth A. Erickson William A. Hall Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy Cancer Medicine neoplasm metastasis oligometastasis pancreatic neoplasms |
| title | Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| title_full | Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| title_fullStr | Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| title_full_unstemmed | Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| title_short | Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| title_sort | characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy |
| topic | neoplasm metastasis oligometastasis pancreatic neoplasms |
| url | https://doi.org/10.1002/cam4.6582 |
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