Background: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection\nand peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such,\nthere is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo\nmetastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients\nwith recurrent PDAC (rPDAC) following curative therapy.\nMethods: In this retrospective study, the Indiana University pancreatic cancer database was used to identify\npatients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics,\ntumor and treatment characteristics were collected. Patients were broadly divided into those who received\nchemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into\nthose who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin\ncombination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis\nwas performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between\ntreated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated\nwith OS.\nResults: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twentythree\npatients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71\npatients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved\nmultiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%)\nwho received other non-standard combinations and the 19 (13%) who received single agent therapy (P = 0.029).\nMultivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy\nand the use of any chemotherapy for rPDAC were associated with improved OS.\nConclusion: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive\nsignificant benefit from these standard combination therapies with median OS that is comparable to what is\nobserved with treatment for de novo mPDAC.
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