Tumori Journal Abstract Book - October 2020 - 51

C - Gastrointestinal (non-Colorectal) Cancers	
Background: To date, surgery represents the only potential
curative treatment in pancreatic ductal adenocarcinoma
(PDAC) patients despite the high relapse rate. The effectiveness of adjuvant (ADJ) chemotherapy was assessed in several
randomized clinical trials (RCTs) showing a modest improvement on survival outcomes. However, these results are limited by the high peri and post-surgical morbidities. The role of
radiotherapy (RT) and neoadjuvant chemotherapy (neoADJ)
remains unclear. The aim of this work is to rank the therapeutic strategies, in order to indicate the most effective clinical
management in patients with resected/resectable PDAC.
Patients and Methods: A systematic literature review of
Pubmed and abstracts from major cancer meetings was carried out including all published prospective RCTs. We performed the pairwise comparisons based on the different
chemotherapy with or without radiotherapy in patients with
resecable/resected PDAC. Primary endpoints are overall
survival (OS) and disease-free survival (DFS). Metaanalysis was conducted with pairwise comparisons by random effect model and the ranking inference was based on
Bayesian approaches.
Results: Our analysis includes 28 RCTs (6603 patients),
19 studies on adjuvant, and 9 studies on neoadjuvant treatment. It was demonstrated a significant OS benefit with
hazard ratio (HR) of 0.81 (CI 0.70-0.94) for the various
combinatory approaches compared to gemcitabine alone
and HR 0.84 (CI 0.73-0.98) vs untreated controls. Finally,
stratifying different settings of treatment we reported: ADJ
HR 0.81 (0.75-0.90), ADJ+RT HR 0.93 (CI 0.77-1.12),
neoADJ+RT HR 0.88 (0.61-1.25), neoADJ 0.72 (0.550.94) as compared to gemcitabine or observation as control arm. The available data allowed DFS analysis for
adjuvant setting only, confirming the OS advantage.
Concerning Bayesian analysis, mFOLFIRINOX rankes as
first option in terms of efficacy.
Conclusions: In the current scenario, ADJ polychemotherapy-based schedules, particularly mFOLFIRINOX,
appear as the first choice. Conversely, the combination of
capecitabine+gemcitabine or gemcitabine monotherapy
represent valid alternatives for patients unfit for aggressive
schedules. Considering the controversial and non-comparable literature data on neoADJ and RT approaches, new
RCTs are eagerly awaited to define their potential role.
Furthermore, innovative RT techniques and/or new targeted agents based on molecular portraits for PDAC could
become changing practice in the next future.

C12
NUTRitional Index for immunecheckpoint inhibitors (ICI)
(NUTRIICI) for patients (pts) with
metastatic Gastro-œsophageal
junction (GOJ)/Gastric Cancer (GC)

51
Morelli C.1, Formica V.1, Lucchetti J.1, Renzi N.1, Nitti D.1, Patrikidou
A.2, Shiu K.K.3, Arkenau T.2, Roselli M.1
1

Policlinico Tor Vergata, Roma; 2Sarah Cannon Research Institute, Londra;
University College Hospital, Londra

3

Background: Nutritional status is strongly related to the
prognosis of mGOJ/GC pts. ICI improved the overall survival (OS) in heavily pre-treated mGOJ/GC pts. The aim
of this retrospective study was to investigate the potential
prognostic role of nutritional markers in ICI-treated
mGOJ/GC pts.
Patients and methods: Twelve serum and anthropometric
nutritional markers derived from blood and CT scans
[weight, body mass Index (BMI), sagittal and waist diameter, waist to hip ratio (WHR), albumin, glucose, lymphocytes, albumin/globulin ratio (AGR), total serum proteins
(PRO), Onodera's prognostic nutritional index] were retrospectively analyzed at baseline. All variables were categorized according to the MaxStat statistics and analyzed
for their prognostic value with univariate (UVA) and multivariate (MVA) cox regression analyses.
Results: From June 2014 to December 2018, 57 mGOJ/GC
pts (14 females, 43 males) (median (m) age 63 years)
received ICI as second-line therapy (Pembrolizumab n=26,
Nivolumab n=16, Avelumab n=15). The mfollow-up was 27
months (mo) (4 to 53 mo). mOS was 10.8 mo (0.2 to 52.2
mo). PRO and WHR were independent predictors for OS in
the MVA (Hazard ratio (HR) 0.98, p 0.01 and HR 1.31, p
0.03, respectively) and used to build the NUTRICI. Pts with
both PRO >60 g/l and WHR >1 had a mOS of 36 mo, vs. 12
mo of pts with one unfavourable factor (either PRO <60 g/l
or WHR<1), vs. 4 mo of pts with both unfavorable factors (p
0.0006). Taking as reference pts with both favorable factors,
HR was 4.16 and 10.08 for pts with one and two unfavourable factors, respectively.
Conclusions: NUTRIICI, combining PRO and WHR, is
the first nutritional index with a significant prognostic
value in mOGJ/GC pts receiving second-line ICIs. A prospective validation is currently under way.

C13
CA19-9 normalized by the
cholestasis indexes direct
bilirubin (BIL), alkaline
phosphatase (ALP) and gammaglutamyl transferase (GGT). CA19-9/
BIL, CA19-9/ALP AND CA19-9/GGT ratios
and overall survival in metastatic
pancreatic cancer (mPC)
Formica V.1, Nitti D.1, Morelli C.1, Lucchetti J.1, Renzi N.1, Del
Vecchio Blanco G.1, Anselmo A.1, Argirò R.1, Benassi M.1, Doldo E.1,
D'angelillo R.M.1, Palmieri G.1, Tisone G.1, Roselli M.1
1

Policlinico Tor Vergata, Roma
Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020
