Multinational observational cohort study of pathological complete response after preoperative chemo(radio)therapy for pancreatic adenocarcinoma

Preoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma. An observational cohort study at 19 centers in 8 countries included all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy with or without radiotherapy from 2010-2018 (n=1758). The rate of pathological complete response (pCR) was 4.8%. pCR was associated with overall survival and recurrence-free survival. Factors associated with pCR included preoperative (modified) FOLFIRINOX, preoperative radiotherapy (particularly stereotactic body radiation therapy), radiologic response, and normal(ized) serum carbohydrate antigen 19-9. The author conclude that, although pCR does not reflect cure, these findings suggest that it is associated with improved OS, and the identified factors associated with pCR may have implications for treatment strategies.