ASO Author Reflections: An Underappreciated Metric: Systemic Chemotherapy Dose Density in Pancreatic Cancer

Increasing recognition of pancreatic cancer as a systemic disease, even when it appears potentially resectable, has placed more emphasis on treatment with systemic chemotherapy. This has resulted in improvements in survival, as seen in numerous clinical trials. These studies routinely report total chemotherapy received in terms of number of cycles and duration, with most patients getting six cycles of systemic therapy;¹ however, these metrics are highly heterogeneous and fail to account for both missed doses and dose reductions. Dose density (DD) is a metric that takes into account these differences and is determined by examining total chemotherapy received compared with what was planned. While some clinical trials have reported on DD, none of these studies have evaluated the association between DD and survival.^{2, 3} Therefore, we sought to evaluate the effect of reduced DD on survival and identify a threshold of systemic therapy that patients should receive to improve survival. …