Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer

Alison Bradley, Colin J McKay, Nigel B Jamieson, Euan J Dickson, Ross Carter, Robert Van Der Meer

Research output: Contribution to journalMeeting abstract

Abstract

Background:
Surgery first (SF) versus neoadjuvant approach (NAT) to management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial. This study is unique in utilizing institutional data to offer Markov decision-analysis of overall treatment pathways for resectable PDAC.

Methods:
An advanced Markov decision analysis model was constructed and populated with data from a retrospective institutional database. Patients presenting with resectable PDAC from 2008-2012 were included in the SF arm. Those presenting with resectable PDAC from 2012-2016 and treated within NAT pathway populated the NAT arm. Model uncertainties were tested with one and two-way deterministic sensitivity analysis and probabilistic Monte Carlo sensitivity analysis set to 1000 cycles with variables altered between highest and lowest observed values.

Results:
NAT pathway gave an additional 0.58 QALMs (22.43 vs. 21.85 QALMs). Monte Carlo analysis reported indifference between treatment strategies. One-way deterministic sensitivity analysis showed that probability of resection in the SF pathway must be greater than 0.82, or below 0.72 in NAT pathway, and probability of receiving adjuvant therapy above 0.6 to alter pathway superiority. Two-way deterministic sensitivity analysis demonstrated treatment superiority depended on resection rate in each pathway and receiving adjuvant therapy in SF pathway. Markov cohort analysis demonstrated superiority of neoadjuvant pathway (Table).

Conclusions:
Optimal treatment pathway remains debatable on an intention-to-treat Markov decision analysis. Markov cohort analysis of treatment received demonstrated benefit with NAT pathway.

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Decision Analysis
Neoadjuvant Therapy
Decision Support Techniques
Pancreatic Neoplasms
Surgery
Pathway
Cancer
Adenocarcinoma
Sensitivity Analysis
Therapeutics
Cohort Studies
Therapy
Decision analysis
Uncertainty
Databases
Model Uncertainty
Lowest
Table

Keywords

  • Markov decision analysis
  • pancreatic cancer
  • neoadjuvant treatment
  • resectable cancer

Cite this

@article{6fa92353521c4e899a10fd68f9295606,
title = "Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer",
abstract = "Background:Surgery first (SF) versus neoadjuvant approach (NAT) to management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial. This study is unique in utilizing institutional data to offer Markov decision-analysis of overall treatment pathways for resectable PDAC.Methods:An advanced Markov decision analysis model was constructed and populated with data from a retrospective institutional database. Patients presenting with resectable PDAC from 2008-2012 were included in the SF arm. Those presenting with resectable PDAC from 2012-2016 and treated within NAT pathway populated the NAT arm. Model uncertainties were tested with one and two-way deterministic sensitivity analysis and probabilistic Monte Carlo sensitivity analysis set to 1000 cycles with variables altered between highest and lowest observed values.Results:NAT pathway gave an additional 0.58 QALMs (22.43 vs. 21.85 QALMs). Monte Carlo analysis reported indifference between treatment strategies. One-way deterministic sensitivity analysis showed that probability of resection in the SF pathway must be greater than 0.82, or below 0.72 in NAT pathway, and probability of receiving adjuvant therapy above 0.6 to alter pathway superiority. Two-way deterministic sensitivity analysis demonstrated treatment superiority depended on resection rate in each pathway and receiving adjuvant therapy in SF pathway. Markov cohort analysis demonstrated superiority of neoadjuvant pathway (Table).Conclusions:Optimal treatment pathway remains debatable on an intention-to-treat Markov decision analysis. Markov cohort analysis of treatment received demonstrated benefit with NAT pathway.",
keywords = "Markov decision analysis, pancreatic cancer, neoadjuvant treatment, resectable cancer",
author = "Alison Bradley and McKay, {Colin J} and Jamieson, {Nigel B} and Dickson, {Euan J} and Ross Carter and {Van Der Meer}, Robert",
year = "2018",
month = "2",
day = "26",
doi = "10.1200/JCO.2018.36.4_suppl.456",
language = "English",
volume = "36",
pages = "456",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
number = "4 suppl",

}

Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer. / Bradley, Alison; McKay, Colin J; Jamieson, Nigel B; Dickson, Euan J; Carter, Ross; Van Der Meer, Robert.

In: Journal of Clinical Oncology, Vol. 36, No. 4 suppl, 26.02.2018, p. 456.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - Markov decision analysis of neoadjuvant treatment pathway versus surgery first pathway for resectable pancreatic cancer

AU - Bradley, Alison

AU - McKay, Colin J

AU - Jamieson, Nigel B

AU - Dickson, Euan J

AU - Carter, Ross

AU - Van Der Meer, Robert

PY - 2018/2/26

Y1 - 2018/2/26

N2 - Background:Surgery first (SF) versus neoadjuvant approach (NAT) to management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial. This study is unique in utilizing institutional data to offer Markov decision-analysis of overall treatment pathways for resectable PDAC.Methods:An advanced Markov decision analysis model was constructed and populated with data from a retrospective institutional database. Patients presenting with resectable PDAC from 2008-2012 were included in the SF arm. Those presenting with resectable PDAC from 2012-2016 and treated within NAT pathway populated the NAT arm. Model uncertainties were tested with one and two-way deterministic sensitivity analysis and probabilistic Monte Carlo sensitivity analysis set to 1000 cycles with variables altered between highest and lowest observed values.Results:NAT pathway gave an additional 0.58 QALMs (22.43 vs. 21.85 QALMs). Monte Carlo analysis reported indifference between treatment strategies. One-way deterministic sensitivity analysis showed that probability of resection in the SF pathway must be greater than 0.82, or below 0.72 in NAT pathway, and probability of receiving adjuvant therapy above 0.6 to alter pathway superiority. Two-way deterministic sensitivity analysis demonstrated treatment superiority depended on resection rate in each pathway and receiving adjuvant therapy in SF pathway. Markov cohort analysis demonstrated superiority of neoadjuvant pathway (Table).Conclusions:Optimal treatment pathway remains debatable on an intention-to-treat Markov decision analysis. Markov cohort analysis of treatment received demonstrated benefit with NAT pathway.

AB - Background:Surgery first (SF) versus neoadjuvant approach (NAT) to management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial. This study is unique in utilizing institutional data to offer Markov decision-analysis of overall treatment pathways for resectable PDAC.Methods:An advanced Markov decision analysis model was constructed and populated with data from a retrospective institutional database. Patients presenting with resectable PDAC from 2008-2012 were included in the SF arm. Those presenting with resectable PDAC from 2012-2016 and treated within NAT pathway populated the NAT arm. Model uncertainties were tested with one and two-way deterministic sensitivity analysis and probabilistic Monte Carlo sensitivity analysis set to 1000 cycles with variables altered between highest and lowest observed values.Results:NAT pathway gave an additional 0.58 QALMs (22.43 vs. 21.85 QALMs). Monte Carlo analysis reported indifference between treatment strategies. One-way deterministic sensitivity analysis showed that probability of resection in the SF pathway must be greater than 0.82, or below 0.72 in NAT pathway, and probability of receiving adjuvant therapy above 0.6 to alter pathway superiority. Two-way deterministic sensitivity analysis demonstrated treatment superiority depended on resection rate in each pathway and receiving adjuvant therapy in SF pathway. Markov cohort analysis demonstrated superiority of neoadjuvant pathway (Table).Conclusions:Optimal treatment pathway remains debatable on an intention-to-treat Markov decision analysis. Markov cohort analysis of treatment received demonstrated benefit with NAT pathway.

KW - Markov decision analysis

KW - pancreatic cancer

KW - neoadjuvant treatment

KW - resectable cancer

UR - https://meetinglibrary.asco.org/record/155923/poster

U2 - 10.1200/JCO.2018.36.4_suppl.456

DO - 10.1200/JCO.2018.36.4_suppl.456

M3 - Meeting abstract

VL - 36

SP - 456

JO - Journal of Clinical Oncology

T2 - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 4 suppl

ER -