https://openworks.mdanderson.org/sumexp22/1036/thumbnail.jp

Jacobson, Galia

Koay, Eugene J., MD, PhD

Thunshelle, Connor

Waterman, Grace L

English

OpenWorks @ MD Anderson

Introduction• BRPC and LAPC have poor prognosis in which surgery is the only curative treatment• RT has a controversial role for BRPC and LAPC, with negative and positive data in recent years• A high biologically effective dose of RT is required to achieve tumor ablation• Since RT can impact the nearby gastrointestinal tract, the use of curative doses is constrained• Previous studies have shown that RT following chemo is associated with better overall survival (OS)ConclusionsReferences1) Awalpreet et al. Radiat Oncol 2017;2:323-3322) Williams et al. Gastrointest Surg 2016;7:1331-423) Reyngold et al. Radiat Oncol 2019;1:954) Rouffiac et al. Cancer Radiother 2021;7:692-6985) Lissoni et al. J Biol Homeost 2015;4:153-86) Venkatesulu et al. Future Oncol 2022;15:1885-1895Table 1. The above four variables showed to be significantly associated with overall survival in the patient population (p<.05). Log-rank and Wilcoxon tests were used to evaluate significance.MethodsIdentifying Biomarkers to Select Patients with Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma (BRPC, LAPC) for Radiotherapy (RT)Grace Waterman, B.A.1; Galia Jacobson, M.D.1; Connor Thunshelle, B.A.1 Eugene Koay M.D.1;1The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Institutional and/or Graduate School of Biomedical Sciences Affiliation Goes HerePrimary Aims• There is an unmet need to identify biomarkers to select subpopulations of patients with BRPC and LAPC for RT• Prior results indicated that CA19-9 response and lymphopenia grade associate with outcomes after RT• Here, we investigated these markers and other clinical factors to identify biomarkers that may aid the decision to use RT for BRPC and LAPC• We hypothesized that lymphopenia grade and CA19-9 normalization would show to be independent predictors of OS• Conducted a retrospective study to analyze patients who received chemotherapy followed by RT for BRPC or LAPC between 2015 and 2020• Patients evaluated as a subset from a larger cohort of 454 patients• RT dates and lowest absolute lymphocyte counts (ALC) during RT periods were extracted from medical records• CA19-9 normalization = minimum CA19-9 value between the start of chemo and 6 months post-chemo < 40 U/mL• Lymphopenia grade >2 = patient ALC fell below 0.5 K/uL during radiation• Associations between variables were tested using Log-rank and Wilcoxon survival analyses • Variables with a p value of <.2 in univariate analysis were used in a multivariate Cox Proportional Hazard survival analysis test to further determine significanceResultsFig 1. Workflow showing how the data set of N = 233 was created along with the number of patients within each subset of tumor type and CA19-9 normalization.Variable Median OS (months) p-valueCA19-9 NormalizationNormalizer = 19.3Non-normalizer = 11.50.015Non-normalizers Receive Surgery?Surgery = 25.4 No surgery = 8.84 0.0001Radiation TypeStereotactic Body RT: 22.7Volumetric Modulated Arc Therapy: 19.13-D Plan: 11.5Intensity-Modulated RT: 10.10.019Tumor Type (Lymphopenia grade>2)BRPC: 23.4LAPC: 11.6 0.003Fig 2. Survival plot for different radiation types.Fig 3. Survival plot for non-normalizers surgery vs non-surgery(0 = no surgery, 1 = surgery).Fig 4. Survival plot for different tumor types of patients with lymphopenia grade >2.VariableHazard Ratio(95% Confidence Interval)P-valueCA19-9 NormalizationNorm: 0.489 (0.318-0.745)Non: 2.04 (1.33-3.14) 0.00012Surgery or No Surgery?Surgery: 0.190 (0.106-0.342)No surgery: 5.25 (2.93-9.42) 0.0001Radiation TypeIMRT: 0.496 (0.279-0.883)SBRT: 0.359 (0.183-0.703)VMAT: 0.402 (0.237-0.680)3-D Plan: 2.49 (1.47-4.21)0.0032Table 2. The above three variables showed to be significant (p<.05) in the multivariate Cox Proportional Hazard Model.• Preliminary analysis indicated CA19-9 to be a significant variable associated with OS as predicted • Lymphopenia grade did not show to be significant as an independent variable• However, there was a significant difference in BPRC vs LAPC OS for patients with lymphopenia grades >2• Additional prospective trials are needed to evaluate the ability of these factors to personalize treatment and solidify stable biomarkersFig 5. Survival plot for CA19-9 normalizers compared to non-normalizers.

Identifying Biomarkers to Select Patients with Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma (BRPC, LAPC) for Radiotherapy (RT)

https://openworks.mdanderson.org/cgi/viewcontent.cgi?article=1036&context=sumexp22

Identifying Biomarkers to Select Patients with Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma (BRPC, LAPC) for Radiotherapy (RT)

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