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Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium

  • Pancreatic Tumors
  • Published:
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Abstract

Background

Major pathologic response (MPR) following neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) patients undergoing resection is associated with improved survival. We sought to determine whether racial disparities exist in MPR rates following NAT in patients with PDAC undergoing resection.

Methods

Patients with potentially operable PDAC receiving at least 2 cycles of neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel ± radiation followed by pancreatectomy (2010-2019) at 7 high-volume centers were reviewed. Self-reported race was dichotomized as Black and non-Black, and multivariable models evaluated the association between race and MPR (i.e., pathologic complete response [pCR] or near-pCR). Cox regression evaluated the association between race and disease-free (DFS) and overall survival (OS).

Results

Results of 486 patients who underwent resection following NAT (mFOLFIRINOX 56%, gemcitabine/nab-paclitaxel 25%, radiation 29%), 67 (13.8%) patients were Black. Black patients had lower CA19-9 at diagnosis (median 67 vs. 204 U/mL; P = 0.003) and were more likely to undergo mild/moderate chemotherapy dose modification (40 vs. 20%; P = 0.005) versus non-Black patients. Black patients had significantly lower rates of MPR compared with non-Black patients (13.4 vs. 25.8%; P = 0.039). Black race was independently associated with worse MPR (OR 0.26, 95% confidence interval [CI] 0.10-0.69) while controlling for NAT duration, CA19-9 dynamics, and chemotherapy modifications. There was no significant difference in DFS or OS between Black and non-Black cohorts.

Conclusions

Black patients undergoing pancreatectomy appear less likely to experience MPR following NAT. The contribution of biologic and nonbiologic factors to reduced chemosensitivity in Black patients warrants further investigation.

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References

  1. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  Google Scholar 

  2. Tesfaye AA, Philip PA. Adjuvant treatment of surgically resectable pancreatic ductal adenocarcinoma. Clin Adv Hematol Oncol. 2019;17(1):54–63.

    Google Scholar 

  3. Truty MJ, Kendrick ML, Nagorney DM, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer. Ann Surg. 2021;273(2):341–9.

    Article  Google Scholar 

  4. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7–33.

    Article  Google Scholar 

  5. Vega EA, Kutlu OC, Salehi O, et al. Preoperative chemotherapy for pancreatic cancer improves survival and R0 rate even in early stage I. J Gastrointest Surg. 2020;24(10):2409–15.

    Article  Google Scholar 

  6. Jang JY, Han Y, Lee H, et al. Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter Phase 2/3 trial. Ann Surg. 2018;268(2):215–22.

    Article  Google Scholar 

  7. Pecorelli N, Licinio AW, Guarneri G, et al. Prognosis of upfront surgery for pancreatic cancer: a systematic review and meta-analysis of prospective studies. Front Oncol. 2021;11:812102.

    Article  Google Scholar 

  8. Singh RR, O’Reilly EM. New treatment strategies for metastatic pancreatic ductal adenocarcinoma. Drugs. 2020;80(7):647–69.

    Article  Google Scholar 

  9. Lei F, Xi X, Batra SK, Bronich TK. Combination therapies and drug delivery platforms in combating pancreatic cancer. J Pharmacol Exp Ther. 2019;370(3):682–94.

    Article  CAS  Google Scholar 

  10. Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110(6):1227–34.

    Article  Google Scholar 

  11. Roland CL, Yang AD, Katz MH, et al. Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer. Ann Surg Oncol. 2015;22(4):1168–75.

    Article  Google Scholar 

  12. Taboada AGM, Lominchar PL, Roman LM, et al. Advances in neoadjuvant therapy for resectable pancreatic cancer over the past two decades. Ann Hepatobiliary Pancreat Surg. 2021;25(2):179–91.

    Article  Google Scholar 

  13. Chawla A, Ferrone CR. Neoadjuvant therapy for resectable pancreatic cancer: an evolving paradigm shift. Front Oncol. 2019;9:1085.

    Article  Google Scholar 

  14. Sohal DP, Walsh RM, Ramanathan RK, Khorana AA. Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy. J Natl Cancer Inst. 2014;106(3):dju011.

    Article  Google Scholar 

  15. Blinn P, Shridhar R, Maramara T, Huston J, Meredith K. Multi-agent neoadjuvant chemotherapy improves response and survival in patients with resectable pancreatic cancer. J Gastrointest Oncol. 2020;11(5):1078–89.

    Article  Google Scholar 

  16. He J, Blair AB, Groot VP, et al. Is a pathological complete response following neoadjuvant chemoradiation associated with prolonged survival in patients with pancreatic cancer? Ann Surg. 2018;268(1):1–8.

    Article  Google Scholar 

  17. Bolton NM, Maerz AH, Brown RE, Bansal M, Bolton JS, Conway WC. Multiagent neoadjuvant chemotherapy and tumor response are associated with improved survival in pancreatic cancer. HPB (Oxford). 2019;21(4):413–8.

    Article  Google Scholar 

  18. Macedo FI, Ryon E, Maithel SK, et al. Survival outcomes associated with clinical and pathological response following neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel chemotherapy in resected pancreatic cancer. Ann Surg. 2019;270(3):400–13.

    Article  Google Scholar 

  19. Khawja SN, Mohammed S, Silberfein EJ, Musher BL, Fisher WE, Van Buren G 2nd. Pancreatic cancer disparities in African Americans. Pancreas. 2015;44(4):522-7.

  20. Tavakkoli A, Singal AG, Waljee AK, et al. Racial disparities and trends in pancreatic cancer incidence and mortality in the United States. Clin Gastroenterol Hepatol. 2020;18(1):171-178.e110.

    Article  Google Scholar 

  21. Wray CJ, Castro-Echeverry E, Silberfein EJ, Ko TC, Kao LS. A multi-institutional study of pancreatic cancer in Harris County, Texas: race predicts treatment and survival. Ann Surg Oncol. 2012;19(9):2776–81.

    Article  Google Scholar 

  22. Heller DR, Nicolson NG, Ahuja N, Khan S, Kunstman JW. Association of treatment inequity and ancestry with pancreatic ductal adenocarcinoma survival. JAMA Surg. 2020;155(2):e195047.

    Article  Google Scholar 

  23. Singal V, Singal AK, Kuo YF. Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis. J Cancer Res Clin Oncol. 2012;138(4):715–22.

    Article  Google Scholar 

  24. Lutfi W, Zenati MS, Zureikat AH, Zeh HJ, Hogg ME. Health disparities impact expected treatment of pancreatic ductal adenocarcinoma nationally. Ann Surg Oncol. 2018;25(7):1860–7.

    Article  Google Scholar 

  25. Scarton L, Yoon S, Oh S, et al. Pancreatic cancer-related health disparities: A commentary. Cancers (Basel). 2018;10(7):235.

    Article  Google Scholar 

  26. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950–2014: over six decades of changing patterns and widening inequalities. J Environ Public Health. 2017;2017:2819372.

    Article  Google Scholar 

  27. Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J Palliat Med. 2009;12(7):623–30.

    Article  Google Scholar 

  28. Brotherton L, Welton M, Robb SW. Racial disparities of pancreatic cancer in Georgia: a county-wide comparison of incidence and mortality across the state, 2000–2011. Cancer Med. 2016;5(1):100–10.

    Article  Google Scholar 

  29. Lutfi W, Hogg ME. ASO Author reflections: health disparities in pancreatic cancer. Ann Surg Oncol. 2018;25(Suppl 3):824–5.

    Article  Google Scholar 

  30. von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.

    Article  Google Scholar 

  31. Vauthey JN, Dixon E. AHPBA/SSO/SSAT consensus conference on resectable and borderline resectable pancreatic cancer: rationale and overview of the conference. Ann Surg Oncol. 2009;16(7):1725–6.

    Article  Google Scholar 

  32. Compton CC, Henson DE. Protocol for the examination of specimens removed from patients with carcinoma of the exocrine pancreas: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med. 1997;121(11):1129–36.

    CAS  Google Scholar 

  33. Oba A, Ho F, Bao QR, Al-Musawi MH, Schulick RD, Del Chiaro M. Neoadjuvant treatment in pancreatic cancer. Front Oncol. 2020;10:245.

    Article  Google Scholar 

  34. Bandera EV, Lee VS, Rodriguez-Rodriguez L, Powell CB, Kushi LH. Racial/ethnic disparities in ovarian cancer treatment and survival. Clin Cancer Res. 2016;22(23):5909–14.

    Article  CAS  Google Scholar 

  35. Boone BA, Steve J, Zenati MS, et al. Serum CA 19–9 response to neoadjuvant therapy is associated with outcome in pancreatic adenocarcinoma. Ann Surg Oncol. 2014;21(13):4351–8.

    Article  Google Scholar 

  36. Ahmad SA, Duong M, Sohal DPS, et al. Surgical outcome results from SWOG S1505: A randomized clinical trial of mFOLFIRINOX versus gemcitabine/nab-paclitaxel for perioperative treatment of resectable pancreatic ductal adenocarcinoma. Ann Surg. 2020;272(3):481–6.

    Article  Google Scholar 

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Funding

National Cancer Institute (NCI), Nipun B. Merchant T32CA211034, National Institutes of Health (NIH), Jashodeep Datta UL1TR002736

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Authors and Affiliations

  1. Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410, Miami, FL, 33136, USA

    Ifeanyichukwu Ogobuiro MD, Amber L. Collier MD, Khadeja Khan BS, Iago de Castro Silva MD, Nipun B. Merchant MD & Jashodeep Datta MD

  2. Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Gregory C. Wilson MD & Syed A. Ahmad MD

  3. Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI, USA

    Patrick B. Schwartz MD & Daniel Abbott MD

  4. Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Alexander A. Parikh MD & Rebecca A. Snyder MD

  5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Chet Hammill MD

  6. Department of Surgery, Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Hong J. Kim MD

  7. Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA

    David A. Kooby MD & Shishir K. Maithel MD

  8. Department of Surgery, Icahn School of Medicine at Mount Sinai Department of Population Health Science and Policy, New York, NY, USA

    Deukwoo Kwon PhD

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  1. Ifeanyichukwu Ogobuiro MD
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  2. Amber L. Collier MD
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Correspondence to Jashodeep Datta MD.

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Ogobuiro, I., Collier, A.L., Khan, K. et al. Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium. Ann Surg Oncol 30, 1485–1494 (2023). https://doi.org/10.1245/s10434-022-12741-4

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