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. 2020 Jun 9;20(1):538.
doi: 10.1186/s12885-020-07016-8.

The impact of neoadjuvant and adjuvant immunotherapy on the survival of pancreatic cancer patients: a retrospective analysis

Saber Amin  1 , Michael Baine  1 , Jane Meza  2 , Chi Lin  3
Affiliations

The impact of neoadjuvant and adjuvant immunotherapy on the survival of pancreatic cancer patients: a retrospective analysis

Saber Amin et al. BMC Cancer. .

Abstract

Background: Immunotherapy has become an essential part of cancer treatment after showing great efficacy in various malignancies. However, its effectiveness in pancreatic ductal adenocarcinoma (PDAC), especially in resectable pancreatic cancer, has not been studied. The primary objective of this study is to compare the OS impact of immunotherapy between PDAC patients who receive neoadjuvant immunotherapy and patients who receive adjuvant immunotherapy. The secondary objective is to investigate the impact of neoadjuvant and adjuvant immunotherapy in combination with chemotherapy and chemoradiation by performing subset analyses of these two groups.

Methods: Patients diagnosed with PDAC between 2004 and 2016 were identified from the National Cancer Database (NCDB). Multivariable Cox proportional hazard analysis was performed to examine the effect of neoadjuvant and adjuvant immunotherapy in combination with chemotherapy and chemoradiation on the OS of the patients. The multivariable analysis was adjusted for essential factors such as the age at diagnosis, sex, race, education, income, place of living insurance status, hospital type, comorbidity score, and year of diagnosis.

Results: Overall, 526 patients received immunotherapy. Among whom, 408/526 (77.57%) received neoadjuvant immunotherapy, and the remaining 118/526 (22.43%) received adjuvant immunotherapy. There was no significant difference in OS between neoadjuvant and adjuvant immunotherapy (HR: 1.06, CI: 0.79-1.41; p < 0.714) in the multivariable analysis. In the univariate neoadjuvant treatment subset analysis, immunotherapy was associated with significantly improved OS compared to no immunotherapy (HR: 0.88, CI: 0.78-0.98; p < 0.026). This benefit disappeared in the multivariable analysis. However, after patients were stratified by educational level, the multivariable Cox regression analysis revealed that neoadjuvant immunotherapy was associated with significantly improved OS (HR: 0.86, CI: 0.74-0.99; p < 0.04) compared to no immunotherapy only in patients with high-level of education, but not in patients with low-level of education.

Conclusion: In this study, no difference in the OS between patients who received neoadjuvant immunotherapy and patients who received adjuvant immunotherapy was noticed. Future studies comparing neoadjuvant adjuvant immunotherapy combined with chemotherapy, radiation therapy, and chemoradiation are needed.

Keywords: Adjuvant therapy; Immunotherapy; Neoadjuvant therapy; Overall survival; Pancreatic adenocarcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall survival neoadjuvant (red) vs. adjuvant (blue) immunotherapy for the entire cohort
Fig. 2
Fig. 2
Overall survival with (blue) or without (red) neoadjuvant immunotherapy for (a) all patients with only neoadjuvant therapies; b patients who received neoadjuvant chemotherapy; c patients who received neoadjuvant chemoradiation
Fig. 3
Fig. 3
Overall survival with (blue) or without (red) adjuvant immunotherapy for (a) all patients with only adjuvant therapies; b patients who received adjuvant chemotherapy or adjuvant chemoradiation
See this image and copyright information in PMC

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