Adjuvant and neoadjuvant treatment patterns among resectable pancreatic cancer patients in the USA

Aim: Chemotherapy is standard before and/or after pancreatic cancer resection, yet benefits of pre-resection chemotherapy are unclear. Real-world pre- and post-resection treatment patterns were evaluated retrospectively. Methods: Neoadjuvant (3-months pre-surgery) and adjuvant (6-months post-surgery) treatment claims from 1 January 2016 to 31 December 2019 in US adults with resectable pancreatic cancer were analyzed. Results: Of the 737 patients, 29% received no chemotherapy in either setting; 22% received chemotherapy in both settings. In the neoadjuvant and adjuvant settings, 69 and 33% of patients, respectively, received no treatment at all. FOLFIRINOX and gemcitabine monotherapy were the most common chemotherapies in the neoadjuvant and adjuvant settings, respectively. Adjuvant FOLFIRINOX increased post-2018, whereas gemcitabine-based regimens decreased. Conclusion: Several chemotherapy regimens were used in both settings. Treatment patterns differed between the two settings.Some patients diagnosed with pancreatic cancer can undergo surgery to remove the tumor. Standard of care is to treat the patient with chemotherapy after the surgery. Chemotherapy is sometimes given before the surgery, yet it is unknown if this pre-treatment is beneficial. This study used insurance claim data from patients with pancreatic cancer in USA to evaluate real-world pre- and post-surgery chemotherapy patterns. Of the 737 analyzed patients, almost a third did not receive chemotherapy at all whereas one-fifth received chemotherapy both pre- and post-surgery. More patients received chemotherapy post-surgery than pre-surgery. Several different chemotherapy regimens were used, but the most common regimens used recently were those that had evidence from clinical trials. Chemotherapy was given more often to patients less than 65 years old than those 65 years or older, indicating more aggressive treatment in younger patients. Overall, the study indicates that a variety of treatments are being used and treatment patterns differ pre- and post-surgery. However, our study also shows that treatment strategies continue to evolve as our understanding of treatment impact and outcomes improves.