Randomized phase 2 trial of addition of metastasis-directed therapy to systemic therapy for oligometastatic pancreatic ductal adenocarcinoma

The multicenter phase 2 EXTEND trial randomized patients with oligometastatic (no more than 5 metastases) pancreatic ductal adenocarcinoma to metastasis-directed therapy (MDT) plus systemic therapy or systemic therapy alone. The primary end point was progression-free survival. At a median follow-up time of 17 months, the median PFS time was 10.3 months (95% CI 4.6-14.0) in de MDT arm versus 2.5 months (1.7-5.1) in the control arm. PFS was significantly improved by the addition of MDT to systemic therapy (HR 0.43; p=0.030). No grade 3 or greater adverse events related to MDT were observed. Systemic immune activation events were associated with MDT and correlated with improved PFS. The authors conclude that these results support the addition of MDT to systemic therapy for patients with oligometastatic PDAC.