Multinational randomized trial of chemotherapy with or without radiofrequency ablation in locally advanced pancreatic cancer

The poor prognosis of patients with locally advanced pancreatic cancer (LAPC) highlights the need for novel therapies to improve survival. The multinational randomized PELICAN trial evaluated the survival impact of addition of radiofrequency ablation (RFA) to chemotherapy in patients with nonprogressive LAPC. The trial included 188 patients (median age 65 years, IQR 57-70, 53% men) with unresectable LAPC with at least stable disease after 2 months of induction chemotherapy. Patients were randomized to RFA plus chemotherapy (n=95) or chemotherapy only (n=93). Primary outcome was overall survival. There were no significant differences between the two groups for the endpoints overall survival and progression-free survival. Grade 3 or higher adverse events were reported more often in the RFA group (27% versus 11%; p=0.004). Changes in Global Health Status quality-of-life scores from baseline indicated deterioration of QOL exceeding the threshold for clinical relevance in the RFA plus chemotherapy group but not in the chemotherapy alone group. The authors conclude that addition of RFA to chemotherapy did not improve survival but adversely impacted quality of life (visual abstract).