Long term results on adjuvant FOLFIRINOX vs Gem in adjuvant pancreatic cancer. Although the survival benefit is quite significant (OS 53.5 vs 35.5 months respectively), I think the tell-tale numbers are the 5 year DFS being 26.1 vs 19%. The modest 7% curative benefit of triplet vs single agent chemotherapy highlights the difficulty in managing this disease and the continued need for investment in GI clinical trials.
Overall Survival Results From the POLO Trial: A Phase III Study of Active Maintenance Olaparib Versus Placebo for Germline BRCA-Mutated Metastatic Pancreatic Cancer
The phase III POLO study demonstrated significant progression-free survival (PFS) benefit for active olaparib maintenance therapy versus placebo for patients with metastatic pancreatic adenocarcinoma and a germline BRCA mutation. Here, we report the final analysis of overall survival (OS) and other secondary end points.
PATIENTS AND METHODS
Patients with a deleterious or suspected deleterious germline BRCA mutation whose disease had not progressed after ≥ 16 weeks of first-line platinum-based chemotherapy were randomly assigned 3:2 to active maintenance olaparib (300 mg twice daily) or placebo. The primary end point was PFS; secondary end points included OS, time to second disease progression or death, time to first and second subsequent cancer therapies or death, time to discontinuation of study treatment or death, and safety and tolerability.
In total, 154 patients were randomly assigned (olaparib, n = 92; placebo, n = 62). No statistically significant OS benefit was observed (median 19.0 v 19.2 months; hazard ratio [HR], 0.83; 95% CI, 0.56 to 1.22; P = .3487). Kaplan-Meier OS curves separated at approximately 24 months, and the estimated 3-year survival after random assignment was 33.9% versus 17.8%, respectively. Median time to first subsequent cancer therapy or death (HR, 0.44; 95% CI, 0.30 to 0.66; P < .0001), time to second subsequent cancer therapy or death (HR, 0.61; 95% CI, 0.42 to 0.89; P = .0111), and time to discontinuation of study treatment or death (HR, 0.43; 95% CI, 0.29 to 0.63; P < .0001) significantly favored olaparib. The HR for second disease progression or death favored olaparib without reaching statistical significance (HR, 0.66; 95% CI, 0.43 to 1.02; P = .0613). Olaparib was well tolerated with no new safety signals.
Although no statistically significant OS benefit was observed, the HR numerically favored olaparib, which also conferred clinically meaningful benefits including increased time off chemotherapy and long-term survival in a subset of patients.
Author Affiliations1The University of Chicago, Chicago, IL 2Paul Brousse Hospital (AP-HP), University Paris-Saclay, Villejuif, France 3IRCCS Ospedale, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy 4University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium 5Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain 6Fox Chase Cancer Center, Philadelphia, PA 7Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 8University College London Cancer Institute, London, United Kingdom 9Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany 10Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea 11St Josef-Hospital, Ruhr University Bochum, Bochum, Germany 12Fondazione Policlinico A Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy 13Klinikum rechts der Isar, Comprehensive Cancer Center Munich TUM, Technische Universität München, Munich, Germany 14Memorial Sloan Kettering Cancer Center, New York, NY 15Merck & Co Inc, Kenilworth, NJ 16AstraZeneca, Cambridge, United Kingdom 17AstraZeneca, Gaithersburg, MD 18The Oncology Institute, Sheba Medical Center at Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel
Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial
Very interesting study which gives more support for preoperatory therapy in the setting of borderline resectable pancreatic cancer. The use of neodjuvant chemotherapy or chemoradiotherapy will likely increase overtime, as systemic options improve, even in pancreatic cancer. Optimal regimen is unknown as studies with other options such as Folfirinox, gemcitabine/albumin-bound paclitaxel are needed, post chemoradiotherapy.