KEY TAKEAWAYS
- The RADAR-PANC trial aimed to investigate that whether early detection and treatment of recurrence can lead to improved survival and QoL in pts with PDAC.
- The primary endpoint was OS.
- The early recurrence surveillance in PDAC may impact QoL despite shared decision-making challenges.
Disease recurrence is one of the biggest concerns in patients (pts) after resection of pancreatic ductal adenocarcinoma (PDAC). Even after the (neo) adjuvant systemic therapy, most pts experience local and/or distant PDAC recurrence within 2 years. High-level evidence regarding the benefits of recurrence-focused surveillance after PDAC resection is lacking.
The impac uidelines regarding post-operative surveillance are based on expert opinion and other low-level evidence.
L A Daamen and the team determined whether recurrence-focused surveillance after PDAC resection improves overall survival and QoL compared to non-standardized clinical follow-up.
Researchers conducted a randomized controlled trial nested within existing prospective cohorts in the Netherlands (Dutch Pancreatic Cancer Project; PACAP) and the United Kingdom (Pancreas Cancer: Observations of Practice and Survival; PACOPS) using the “Trials within Cohorts” (TwiCs) design.
All PACAP/PACOPS participants with histologically confirmed PDAC who underwent a macroscopically radical resection (R0-R1), with provided informed consent for TwiCs participated in quality of life (QoL) questionnaires, were included. Pts were randomized to the intervention arm received recurrence-focused surveillance, including clinical evaluation, serum cancer antigen (CA) 19-9 testing, and contrast-enhanced computed tomography (CT) of the chest and abdomen every three months during the first 2 years after surgery.
Pts in the control arm underwent non-standardized clinical follow-up, generally consisting of clinical evaluations with imaging and serum tumor marker testing only upon symptom onset, according to local practice in the participating hospital. The primary endpoint is overall survival.
Secondary endpoints include QoL, patterns of recurrence, compliance with and costs of recurrence-focused follow-up, and the impact over recurrence-focused treatment.
The trial generated high-level evidence for the current clinical relevance regarding the value of recurrence-focused postoperative surveillance with serial tumor marker testing and routine imaging in pts after PDAC resection. The trials within Cohort design allowed the investigation of acceptability of recurrence-focused surveillance among cohort pts and increased the generalizability of findings to the general population.
The study concluded that although it is strongly encouraged to offer all pts, treatment at the time of recurrence diagnosis, the type and timing of treatment will be determined through shared decision-making. This might reduce the potential survival benefits of recurrence-focused surveillance, although insights into the impact on pts’ QoL will be obtained.
The trial was sponosred by UMC Utrecht.
Source: https://pubmed.ncbi.nlm.nih.gov/38902836/
Clinical Trial: https://clinicaltrials.gov/study/NCT04875325
Daamen L.A., Van Goor I.W.J.M., Groot V.P., et al. (2024). “Recurrent disease detection after resection of pancreatic ductal adenocarcinoma using a recurrence-focused surveillance strategy (RADAR-PANC): protocol of an international randomized controlled trial according to the Trials within Cohorts design.” Trials. 2024 Jun 20;25(1):401. doi: 10.1186/s13063-024-08223-5. PMID: 38902836; PMCID: PMC11188210.
