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Nab-paclitaxel plus S-1 with or without PD-1 inhibitor in pancreatic ductal adenocarcinoma with only hepatic metastases: a retrospective cohort study

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Abstract

Purpose

The evidence regarding programmed cell death 1 (PD-1) inhibitors on pancreatic ductal adenocarcinoma (PDAC) with metastases remains controversial. This study aimed to assess the efficacy and safety of Nab-paclitaxel plus S1 (NPS) with or without Sintilimab, a PD-1 inhibitor, in patients with PDAC with only hepatic metastases (mPDAC).

Methods

Untreated mPDAC patients who received NPS with (the combination group) or without Sintilimab (the NPS group) were retrospectively studied. Surgery was considered when the pancreatic tumor became resectable or borderline resectable on radiological examinations, and with complete metabolic response of liver metastases.

Results

Between October 2017 and February 2020, 32 patients were in the combination group and 34 patients in the NPS group. Successful salvage resection was achieved in 17 (25.8%) patients after tumor-downstaging (combination 12 vs. NPS 5, P = 0.03). The median overall survival (OS) was 16.8 months in the combination group and 10.0 months in the NPS group (P = 0.002). Remarkable OS benefit was observed in patients with decline in CA19-9 of ≥ 50% (16.0 vs. 6.5, P = 0.003), reduction in 18F-fluorodeoxyglucose uptake of primary tumor of ≥ 50% (16.5 vs. 10.0, P < 0. 001) and after salvage resection (20.1 vs. 11.0, P < 0. 001). No significant difference in Grade 3 or higher adverse events were seen between the two groups (40.6% vs. 32.4%, P = 0.49).

Conclusions

Despite the inherent biases of this retrospective study, the addition of Sintilimab significantly improved salvage resection rates and OS compared with the NPS regimen and had a favorable safety profile in treatment naïve mPDAC patients.

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Acknowledgements

We would like to thank Xiaomo Li from Genetron Health (Beijing) Technology, Co. Ltd for her assistance with the figures. Part of this work was accepted as an abstract for a poster presentation (Poster 1532P) at the European Society for Medical Oncology Congress 2020.

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Authors and Affiliations

  1. Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Qu Liu, Guodong Zhao, Xiuping Zhang, Nan Jiang, Zhiming Zhao, Yang Wang, Shuai Xu, Lin Zhu & Rong Liu

  2. Faculty of Oncology, the Fifth Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Qu Liu & Guanghai Dai

  3. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China

    Wan Yee Lau

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  1. Qu Liu
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Contributions

Study concept and design: QL, GD and RL. Performance of operation: GZ, NJ, ZZ and RL. Drafting of the manuscript: QL, GZ, XZ and NJ. Data collection and analysis: NJ, YW, SX, and LZ. Critical revision of the manuscript for important intellectual content: QL, GD and RL. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Guanghai Dai or Rong Liu.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the Declaration of Helsinki. Written informed consent was obtained from patient for publication of this report and any associated images.

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The authors declare no competing interests.

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Qu Liu, Guodong Zhao, Xiuping Zhang and Nan Jiang contributed equally to this work, and should be considered first author.

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Liu, Q., Zhao, G., Zhang, X. et al. Nab-paclitaxel plus S-1 with or without PD-1 inhibitor in pancreatic ductal adenocarcinoma with only hepatic metastases: a retrospective cohort study. Langenbecks Arch Surg 407, 633–643 (2022). https://doi.org/10.1007/s00423-021-02321-7

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  • DOI: https://doi.org/10.1007/s00423-021-02321-7

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