3451 - Outcomes in Borderline Resectable Pancreatic Cancer: Impact of Integrated Pathologic Score
Presenter(s)
T. Jacobsen1, N. Nardella2, A. Oraiqat2, R. F. Palm3, T. Biachi de Castria4, D. W. Kim4, P. Hodul5, J. W. Denbo5, A. Sinnamon5, J. Pimiento5, M. Malafa5, M. L. Sandoval6, L. N. Silverman6, J. M. Frakes6, and S. Hoffe6; 1Lake Erie College of Osteopathic Medicine - Bradenton, Tampa, FL, 2H. Lee Moffitt Cancer Center, Tampa, FL, 3The Ohio State University, Columbus, OH, 4H. Lee Moffitt Cancer Center and Research Institute, Department of Medical Oncology, Tampa, FL, 5H. Lee Moffitt Cancer Center and Research Institute, Department of Surgical Oncology, Tampa, FL, 6H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
Purpose/Objective(s): The Integrated Pathologic Score integrating the College of American Pathologists (IPSCAP) grading system independently predicts overall survival (OS) in patients with resected pancreatic adenocarcinoma after non-ablative neoadjuvant therapy. This study analyzes the impact of IPSCAP on the outcomes of borderline resectable pancreas cancer (BRPC) patients resected after FOLFIRINOX (FFX) chemotherapy and 5 fraction Stereotactic Body Radiation Therapy (SBRT).
Materials/Methods: This IRB approved retrospective study evaluated resected patients treated after FFX/SBRT from 2013-2023. SBRT dose was categorized by =40 or <40 Gy. The number of FFX cycles was determined by investigator discretion. Demographic and tumor characteristic data were collected. IPSCAP was calculated by adding the ypT, ypN for patients with at least 12 nodes examined, and TRG scores with classification in groups 1 (0-3), 2 (4-6) and 3 (7-8). Presence or absence of actionable somatic and germline mutations were identified*. Median OS was defined as time from biopsy to date of death or last contact (months). One tailed Mann-Whitney U test was used for significance.
Results: Of the 177 BRPC patients resected after neoadjuvant therapy, 76 (43%) received FFX/SBRT, with 71 (40%) meeting eligibility criteria. Group 1 consisted of 29.6% of patients compared with Group 2 (67.6%) and Group 3 (2.8%). Table 1 displays cohort characteristics. KRAS was present in all but two patients (Group 2) tested to have actionable somatic mutations*. IPSCAP was lower (Group 1-2) in patients with germline mutations. Across all groups the median number of FFX cycles was ~6 cycles. Combined OS was highest in Group 1 with 37 months (10-88) and significantly higher than Group 2 of 26.5 months (p=0.03). Patients receiving =40 Gy compared to <40 Gy had improved OS (29.5 vs 24 months) (p=0.35) with 81% of Group 1 dosed = 40 Gy. * Actionable somatic mutations include BRCA1, BRCA2, KRAS; Actionable germline mutations include ATM, BRCA1, PALB2.
Conclusion: IPSCAP scoring in patients resected after a median of 6 cycles of FFX followed by SBRT correlated with improved OS in Group 1 patients, warranting further study to optimize neoadjuvant parameters.
Abstract 3451 - Table 1: Cohort characteristics| Group 1 (N=21) | Group 2 (N=48) | Group 3 (N=2) | |
| Age | 67 (34-77) | 66 (47-80) | 56 (55-57) |
| Gender Female Male | 71% (15) 29% (6) | 52% (25) 48% (23) | 50% (1) 50% (1) |
| Neoadjuvant 5FU # of Cycles # of Months | 6 (3-12) 3 (2-6) | 6 (3-11) 3 (1-14) | 6.5 (5-8) 3 (2-4) |
| Mutations (% of # Tested) Actionable Germline* Actionable Somatic* | 13% (2/15) 83% (5/6) | 14% (5/35) 63% (19/30) | 0% (0/2) 100% (2/2) |
| OS | 37 (10-88) | 26.5 (10-67) | 42.5 (20-65) |
| OS <40 Gy =40 Gy | 47(13-88) 37 (10-70) | 24(17-31) 27 (10-67) | - 42.5 (20-65) |
| yPT Stage ypT0 ypT1 ypT2 ypT3 ypT4 | 10% (2) 86% (18) 4% (1) 0 0 | 0 19% (9) 54% (26) 25% (12) 2% (1) | 0 0 0 100% (3) 0 |
| yPN Stage ypN0 ypN1 ypN2 ypN3 | 76% (16) 24% (5) 0 0 | 46% (22) 44% (21) 10% (5) 0 | 0 0 100% (2) 0 |
| CAP TRG Grade 0 Grade 1 Grade 2 Grade 3 | 10% (2) 62% (13) 29% (6) 0 | 0 2% (1) 85% (41) 12% (6) | 0 0 50% (1) 50% (1) |