Optimizing Patient Selection for Irreversible Electroporation of Locally Advanced Pancreatic Cancer: Analyses of Survival

Matthew R Woeste; Khaleel D Wilson; Edward J Kruse; Matthew J Weiss; John D Christein; Rebekah R White; Robert C G Martin 2nd

doi:10.3389/fonc.2021.817220

Optimizing Patient Selection for Irreversible Electroporation of Locally Advanced Pancreatic Cancer: Analyses of Survival

Front Oncol. 2022 Jan 13:11:817220. doi: 10.3389/fonc.2021.817220. eCollection 2021.

Authors

Matthew R Woeste¹, Khaleel D Wilson¹, Edward J Kruse², Matthew J Weiss³, John D Christein⁴, Rebekah R White⁵, Robert C G Martin 2nd¹

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, United States.
² Department of Surgery, Section of Surgical Oncology, Augusta University Medical Center, Augusta, GA, United States.
³ Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD, United States.
⁴ Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama, Birmingham, AL, United States.
⁵ Gastrointestinal Cancer Unit, University of California San Diego Moores Cancer Center, San Diego, CA, United States.

Abstract

Background: Irreversible electroporation (IRE) has emerged as a viable consolidative therapy after induction chemotherapy, in which this combination has improved overall survival of locally advanced pancreatic cancer (LAPC). Optimal timing and patient selection for irreversible electroporation remains a clinically unmet need. The aim of this study was to investigate preoperative factors that may assist in predicting progression-free and overall survival following IRE.

Methods: A multi-institutional, prospectively maintained database was reviewed for patients with LAPC treated with induction chemotherapy followed by open-technique irreversible electroporation from 7/2015-5/2019. RECIST 1.1 criteria were used to assess tumor response and radiological progression. Overall survival (OS) and progression-free survival (PFS) were recorded. Survival analyses were performed using Kaplan Meier and Cox multivariable regression analyses.

Results: 187 LAPC patients (median age 62 years range, 21 - 91, 65% men, 35% women) were treated with IRE. Median PFS was 21.7 months and median OS from diagnosis was 25.5 months. On multivariable analysis, age ≤ 61 (HR 0.41, 95%CI 0.21-0.78, p<0.008) and no prior radiation (HR 0.49, 95%CI 0.26-0.94, p=0.03) were positive predictors of OS after IRE. Age ≤ 61(HR 0.53, 95%CI, 0.28-.99, p=0.046) and FOLFIRINOX followed by gemcitabine/abraxane induction chemotherapy (HR 0.37,95%CI 0.15-0.89, p=0.027) predicted prolonged PFS after IRE. Abnormal CA19-9 values at the time of surgery negatively impacted both OS (HR 2.46, 95%CI 1.28-4.72, p<0.007) and PFS (HR 2.192, 95%CI 1.143-4.201, p=0.018) following IRE.

Conclusions: Age, CA 19-9 response, avoidance of pre-IRE radiation, and FOLFIRINOX plus gemcitabine/abraxane induction chemotherapy are prominent factors to consider when referring or selecting LAPC patients to undergo IRE.

Keywords: irreversible electroporation (IRE); locally advanced pancreatic cancer; overall survival; patient selection; progression free survival; recurrence.