VHIO-led study shows that 3.4% of patients who relapse after surgery for pancreatic cancer present with lung oligometastasis

Led by investigators of VHIO’s Upper Gastrointestinal Cancer Translational Research Laboratory, an international retrospective, multicenter study was designed to clinically and genomically characterize pancreatic ductal adenocarcinoma (PDAC) patients with oligometastatic lung disease (OMLD).

The results of these analyses, now published as an original article in ESMO Gastrointestinal Oncology*—a recently launched open access journal from the European Society for Medical Oncology—show that OMLD is a clinically distinct subgroup of disease with a better prognosis.

PDAC accounts for approximately 95% of all pancreatic cancers and is estimated to rank as the main cause of cancer mortality by the year 2040. This tumor type is also one of the most lethal of all cancers, for which surgery plus adjuvant chemotherapy is currently the only curative treatment option. Upon surgical resection, disease relapse unfortunately occurs in around 80% of these patients at five years and more than 60% of patients suffer disease recurrence at two years post-surgery.

“Among patients with distant recurrence in one organ of the body, the most common location of disease relapse is the liver followed by the peritoneum, lung, lymph nodes and bones, among others,” said corresponding author Teresa Macarulla, Head of VHIO’s Upper Gastrointestinal Cancer Translational Research Laboratory and the Upper Gastrointestinal and Endocrine Tumors Unit at the Vall d’Hebron University Hospital (HUVH).

“Lung-only relapse following surgical resection of pancreatic ductal adenocarcinoma is rare. The aim of our study was to assess if the volume of lung metastasis and mutation rate could predict a better prognosis in these patients,” added first author Natalia Tissera, Medical Oncologist and Predoctoral Investigator of the same VHIO lab.

Oligometastasis is a less aggressive form of metastatic disease and is characterized by a lower tumor burden and localization. The investigators retrospectively analyzed the clinical and genomic characteristics of 39 patients with oligometastatic lung disease (OMLD) and compared these features with those without OMLD. Findings show that 3.4% of PDAC patients who relapsed after surgery presented with OMLD.

“We have observed that patients with oligometastatic lung disease represent a clinically distinct subgroup with better overall as well as progression-free survival,” said Tissera.

Median progression-free survival was 23.3 months in patients with OMLD versus 10.7 months in those without oligometastatic disease, with a median overall survival of 35.7 months and 26.2 months, respectively.

“PDAC driver mutations, KRAS, TP53, CDKN2A and SMAD4, were found at similar rates in both groups. Further studies are therefore needed to achieve a better understanding of OMLD and toward developing new treatment strategies,” concluded co-author Tian Tian, Preclinical Group Leader of VHIO’s Upper Gastrointestinal Cancer Translational Research Laboratory.

Reference: *N.S. Tissera, M. Chiaravalli , A. Turpin, R. Luca , F. Castet, C. Fabregat-Franco, G. Castillo , D. López-Valbuena, G. Tortora, P. Hammel, J.M. O’Connor, J. Matito, A. Vivancos, T.V. Tian, T. Macarulla. Clinical and genomic characterization of pancreatic ductal adenocarcinoma patients with lung oligometastasis. ESMO GI. Vol 2, Dec. 2023. https://doi.org/10.1016/j.esmogo.2023.08.010