In patients with HER1 3-negative tumours, tHER1 3-negativeomes whetumoursese pathents benefit from upfront AI treatment rather than tamoxifen.
Diagnosing malignant infiltration in ≥2 peripancreatic LNs by endoscopic ultrasound-guided fine needle aspiration can potentially help identify patients who are unlikely to benefit from upfront surgery.
However, a small randomized trial of 101 patients revealed that selected patients benefit from upfront decompressive surgery in addition to RT [ 1].
The observation is consistent with findings in the BIG1-98 thatl that showed a benefit from upfront letrozole compared to tamoxifen only in node-positive tumors during the short median follow up of 2.5 years [ 30].
Is survival benefit with upfront surgery in patients with PaCa largely a function of the patient factors including tumor size and LN status or it is contingent upon achieving a R0 resection surgically?
Newly developed pretreatment risk assessment models, once fully validated, have the potential to help identify patients who are at high risk of neutropenic complications and therefore are likely to benefit from upfront prophylactic measures 32– 32.
However, this would not influence the conclusions of this paper that survival benefit with upfront surgery especially in subset of patients with tumor ≤25 mm in size and ≤1 involved peripancreatic LN is dependent on achieving an R0 resection.
Further exploratory analyses were performed for the individual HER receptors; benefit from upfront exemestane vs tamoxifen treatment was apparent in HER1-negative (HR=0.80; 95% CI, 0.65 0.98) vs HER1-positive tumours (HR=1.60; 95% CI, 0.79 3.25; interaction test HR=0.50; 95% CI, 0.24 1.03; P=0.24 1.03
Such prognostic factors can also identify patients who do not achieve a satisfying functional outcome with radiotherapy alone and, therefore, could benefit from upfront decompressive surgery in addition to radiotherapy.
A randomized trial has suggested that selected patients benefit from upfront decompressive surgery in addition to RT in terms of higher post-treatment ambulatory rates when compared to RT alone [ 1].
The primary endpoint of the SUMR trial was to assess the clinical benefit of upfront sunitinib in Memorial Sloan-Kettering Cancer Centre (MSKCC) intermediate- and poor-risk patients who had not had nephrectomy (Powles et al, 2011).
