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4. Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial

Author

Jones, Robert P, Psarelli, Eftychia-Eirini, Jackson, Richard, Ghaneh, Paula, Halloran, Christopher M, Palmer, Daniel H, Campbell, Fiona, Valle, Juan W, Faluyi, Olusola, O'Reilly, Derek A, Cunningham, David, Wadsley, Jonathan, Darby, Suzanne, Meyer, Tim, Gillmore, Roopinder, Anthoney, Alan, Lind, Pehr, Glimelius, Bengt, Falk, Stephen, Izbicki, Jakob R, Middleton, Gary William, Cummins, Sebastian, Ross, Paul J, Wasan, Harpreet, McDonald, Alec, Crosby, Tom, Ting, Yuk, Patel, Kinnari, Sherriff, David, Soomal, Rubin, Borg, David, Sothi, Sharmila, Hammel, Pascal, Lerch, Markus M, Mayerle, Julia, Tjaden, Christine, Strobel, Oliver, Hackert, Thilo, Buchler, Markus W, Neoptolemos, John P, Hill, Mark, Corrie, Pippa, Hickish, Tamas, Napier, Mark, Slater, Sarah, Valle, Juan, Shablak, Alaaeldin, Cunnell, Michelle, Guimbaud, Rosine, Roques, Tom, Iveson, Tim, Jamil, Arshad, Robinson, Angus, Garcia-Alonso, Angel, Chang, David, Tsang, David, Wadd, Nick, Wall, Lucy, Nielsen, Niels Hilmer, Lerch, Markus, Mehta, Ajay, Sivaramalingam, Muthiah, Fyfe, David, Osborne, Richard, Blesing, Claire, Bulusu, Venkata Ramesh, Rathbone, Emma, Seitz, Jean-Francois, Beaumont, Erica, Dernedde, Ulrike, McAdam, Karen, Dimopoulos, Prokopios, Cominos, Mathilda, Askill, Colin, Piwowar, Andrzej, Bachet, Jean-Baptiste, Sumpter, Kate, Raouf, Sherif, Nicoll, Jonathan, Rees, Charlotte, Dhinakaran, Kathirvelu, Haux, Johan, Bengrine-Lefevre, Leila, Terrebonne, Eric, Shankland, Catherine, Palmer, Cheryl, Medley, Louise, Toy, Elizabeth, Kaur, Jasvinder, Gupta, Kamalnayan, Cheeseman, Sue, Patterson, Daniel, Candish, Charles, Thompson, Joyce, Coxon, Fareeda, Connolly, Caroline, McPhail, Neil, Williams, Rachel, Flygare, Petra, Elmlund, Mattias, Artru, Pascal, Millat, Bertrand, and Canc, European Study Grp Pancreatic

Subjects
medicine.medical_specialty, Chemotherapy, Randomization, business.industry, medicine.medical_treatment, 030230 surgery, medicine.disease, Gastroenterology, Gemcitabine, law.invention, Capecitabine, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030220 oncology & carcinogenesis, Internal medicine, Pancreatic cancer, medicine, Carcinoma, Surgery, Prospective cohort study, business, medicine.drug
Abstract

Importance The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear. Objective To define patterns of recurrence after adjuvant chemotherapy and the association with survival. Design, Setting, and Participants Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019. Interventions Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine. Main Outcomes and Measures Overall survival, recurrence, and sites of recurrence. Results Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98;P = .03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45;P = .04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09;P = .27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32 months) was not significantly different from those with only local recurrence (24.83 months; 95% CI, 22.96-27.63 months) (P = .85 andP = .35, respectively). Gemcitabine plus capecitabine had a 21% reduction of death following recurrence compared with monotherapy (HR, 0.79; 95% CI, 0.64-0.98;P = .03). Conclusions and Relevance There were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence. Pancreatic cancer behaves as a systemic disease requiring effective systemic therapy after resection. Trial Registration ClinicalTrials.gov identifier:NCT00058201, EudraCT 2007-004299-38, and ISRCTN 96397434.

Published
2019

5. Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma : A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial

Author

Jones, Robert P., Psarelli, Eftychia-Eirini, Jackson, Richard, Ghaneh, Paula, Halloran, Christopher M., Palmer, Daniel H., Campbell, Fiona, Valle, Juan W., Faluyi, Olusola, O'Reilly, Derek A., Cunningham, David, Wadsley, Jonathan, Darby, Suzanne, Meyer, Tim, Gillmore, Roopinder, Anthoney, Alan, Lind, Pehr, Glimelius, Bengt, Falk, Stephen, Izbicki, Jakob R., Middleton, Gary William, Cummins, Sebastian, Ross, Paul J., Wasan, Harpreet, McDonald, Alec, Crosby, Tom, Ting, Yuk, Patel, Kinnari, Sherriff, David, Soomal, Rubin, Borg, David, Sothi, Sharmila, Hammel, Pascal, Lerch, Markus M., Mayerle, Julia, Tjaden, Christine, Strobel, Oliver, Hackert, Thilo, Buchler, Markus W., Neoptolemos, John P., Hill, Mark, Corrie, Pippa, Hickish, Tamas, Napier, Mark, Slater, Sarah, Valle, Juan, Shablak, Alaaeldin, Cunnell, Michelle, Guimbaud, Rosine, Roques, Tom, Iveson, Tim, Jamil, Arshad, Robinson, Angus, Garcia-Alonso, Angel, Chang, David, Tsang, David, Wadd, Nick, Wall, Lucy, Nielsen, Niels Hilmer, Lerch, Markus, Mehta, Ajay, Sivaramalingam, Muthiah, Fyfe, David, Osborne, Richard, Blesing, Claire, Bulusu, Venkata Ramesh, Rathbone, Emma, Seitz, Jean-Francois, Beaumont, Erica, Dernedde, Ulrike, McAdam, Karen, Dimopoulos, Prokopios, Cominos, Mathilda, Askill, Colin, Piwowar, Andrzej, Bachet, Jean-Baptiste, Sumpter, Kate, Raouf, Sherif, Nicoll, Jonathan, Rees, Charlotte, Dhinakaran, Kathirvelu, Haux, Johan, Bengrine-Lefevre, Leila, Terrebonne, Eric, Shankland, Catherine, Palmer, Cheryl, Medley, Louise, Toy, Elizabeth, Kaur, Jasvinder, Gupta, Kamalnayan, Cheeseman, Sue, Patterson, Daniel, Candish, Charles, Thompson, Joyce, Coxon, Fareeda, Connolly, Caroline, McPhail, Neil, Williams, Rachel, Flygare, Petra, Elmlund, Mattias, Artru, Pascal, Millat, Bertrand, Jones, Robert P., Psarelli, Eftychia-Eirini, Jackson, Richard, Ghaneh, Paula, Halloran, Christopher M., Palmer, Daniel H., Campbell, Fiona, Valle, Juan W., Faluyi, Olusola, O'Reilly, Derek A., Cunningham, David, Wadsley, Jonathan, Darby, Suzanne, Meyer, Tim, Gillmore, Roopinder, Anthoney, Alan, Lind, Pehr, Glimelius, Bengt, Falk, Stephen, Izbicki, Jakob R., Middleton, Gary William, Cummins, Sebastian, Ross, Paul J., Wasan, Harpreet, McDonald, Alec, Crosby, Tom, Ting, Yuk, Patel, Kinnari, Sherriff, David, Soomal, Rubin, Borg, David, Sothi, Sharmila, Hammel, Pascal, Lerch, Markus M., Mayerle, Julia, Tjaden, Christine, Strobel, Oliver, Hackert, Thilo, Buchler, Markus W., Neoptolemos, John P., Hill, Mark, Corrie, Pippa, Hickish, Tamas, Napier, Mark, Slater, Sarah, Valle, Juan, Shablak, Alaaeldin, Cunnell, Michelle, Guimbaud, Rosine, Roques, Tom, Iveson, Tim, Jamil, Arshad, Robinson, Angus, Garcia-Alonso, Angel, Chang, David, Tsang, David, Wadd, Nick, Wall, Lucy, Nielsen, Niels Hilmer, Lerch, Markus, Mehta, Ajay, Sivaramalingam, Muthiah, Fyfe, David, Osborne, Richard, Blesing, Claire, Bulusu, Venkata Ramesh, Rathbone, Emma, Seitz, Jean-Francois, Beaumont, Erica, Dernedde, Ulrike, McAdam, Karen, Dimopoulos, Prokopios, Cominos, Mathilda, Askill, Colin, Piwowar, Andrzej, Bachet, Jean-Baptiste, Sumpter, Kate, Raouf, Sherif, Nicoll, Jonathan, Rees, Charlotte, Dhinakaran, Kathirvelu, Haux, Johan, Bengrine-Lefevre, Leila, Terrebonne, Eric, Shankland, Catherine, Palmer, Cheryl, Medley, Louise, Toy, Elizabeth, Kaur, Jasvinder, Gupta, Kamalnayan, Cheeseman, Sue, Patterson, Daniel, Candish, Charles, Thompson, Joyce, Coxon, Fareeda, Connolly, Caroline, McPhail, Neil, Williams, Rachel, Flygare, Petra, Elmlund, Mattias, Artru, Pascal, and Millat, Bertrand

Abstract

Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear. Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival. Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019. Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine. Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence. Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P=.03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P=.04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P=.27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32

Published
2019
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6. Art as an opinion and expression

Author

Connolly, Caroline

Subjects
News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly In the wake of the Nov. 8 election results, senior journalism major Josie Jimenez created artistic stamps to express her anti-Trump views. Blue word art plays on [...]

Published
2016

7. Miranda Sings for Netflix this fall

Author

Connolly, Caroline

Subjects
Singers, News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly In 2008, comedienne Colleen Ballinger made her first YouTube debut as Miranda Sings. Within the same year, Ballinger also graduated from APU as a vocal performance major. [...]

Published
2016

8. The Netflix phenomenon

Author

Connolly, Caroline

Subjects
News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly I don't know about you, but Netflix is pretty much life for me. It's a great way to relieve the stress of college life, and I enjoy [...]

Published
2016

9. Queen Bey gets in 'Formation'

Author

Connolly, Caroline

Subjects
News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly I am possibly one of Beyoncé's biggest fans. My Instagram name is @__caroyonce__ for crying out loud. Beyoncé always does her thing, and it does not matter [...]

Published
2016

10. Azusa and Glendora salute veterans

Author

Connolly, Caroline

Subjects
United States. Army, College faculty -- Appreciation, Veterans -- Appreciation, News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly The 10th annual 'Saluting Our Veterans' event provided a way for attendees to give thanks and support to American troupers as the nation celebrates all veterans on [...]

Published
2015

11. Callum Wallace poses dangerous scoring threat

Author

Connolly, Caroline

Subjects
Soccer players, News, opinion and commentary, Sports and fitness, Manchester United Football Club
Abstract

Byline: Caroline Connolly When freshman Callum Wallace headed home his first collegiate goal on Sept. 24 against Dixie State in St. George, Utah, it was the end of a long [...]

Published
2015

12. UCO sings how 'stories are worth telling'

Author

Connolly, Caroline

Subjects
Concerts, News, opinion and commentary, Sports and fitness
Abstract

Byline: Caroline Connolly University Choir and Orchestra held its first concert of the year at 6 p.m. on Saturday in Upper Turner Campus Center. With the celebration of its 35th [...]

Published
2015

14. Outcomes Following Interval Debulking Surgery in Primary Peritoneal Carcinoma.

Author

Connolly CF, Yahya S, Chan KK, Singh K, Sundar S, Anwar SM, and Fernando I

Subjects
Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Middle Aged, Peritoneal Neoplasms mortality, Peritoneal Neoplasms pathology, Retrospective Studies, Survival Analysis, Treatment Outcome, Cytoreduction Surgical Procedures methods, Peritoneal Neoplasms surgery
Abstract

Aim: Primary peritoneal carcinoma (PPC) has a poor prognosis, with a median survival of 11-24 months. Unlike ovarian cancer, there exist no published data on the effectiveness of interval debulking surgery (IDS) in PPC and it is not routine practice. Our series compared outcomes in patients with PPC treated with IDS following chemotherapy versus patients treated with chemotherapy alone., Patients and Methods: A retrospective case-note analysis was undertaken of all patients diagnosed with PPC in the Pan-Birmingham network between May 2000 and October 2008. Data were analysed for age, performance status, response to chemotherapy, surgical outcomes, subsequent treatments, site of relapse, median progression-free (PFS) and overall (OS) survival. Analysis for PFS and OS was undertaken using both Kaplan-Meier and log-rank analysis., Results: A total of 44 patients with histologically-proven PPC were identified: 41 patients received chemotherapy with platinum combination or alone; 17/44 (39%) of patients underwent IDS following chemotherapy and 15 of these had optimal debulking; 3/15 (20%) had a complete pathological response. The recurrence rate for the surgical group was 11/17 (65%) including those with suboptimal debulking, whereas disease recurred in 25/27(93%) of the non-surgical group. The median PFS was 25 months (range=8-33 months) in the IDS group compared to 9 months (range=0-30 months) in the non-surgical group (p=0.001). The median OS was 48 months in the IDS group compared to 18 months in the non-surgical group (p=0.0016). The median OS for the whole patient cohort was 32 months., Conclusion: The median OS for the whole cohort compares favourably with previously published survival data of 11-24 months. IDS in selected cases of PPC appears to improve median OS and PFS in PPC and we would recommend that surgery is considered as a treatment option in all patients who have a good response to chemotherapy or entry into a clinical trial., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Published
2016

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