Supportive / QoL
2026-05-30
SPIN Score (Celiac Plexus SRS) NCT03323489
ForPancreatic cancer, intractable retroperitoneal pain, planned celiac plexus SRS
TL;DR89% pain response in SPIN-2 pts (baseline pain >6 + no prior neurotoxic chemo) vs 32% SPIN-0 after celiac SRS.
| SPIN score | Response rate | n |
|---|---|---|
| 0 | 32% | 31 |
| 1 | 53% | 40 |
| 2 | 89% | 19 |
8 details
Methods
- 🔍 Post-hoc analysis of 90 evaluable pts from pivotal ph2 (NCT03323489; Lancet Oncol 2024:25:1070-79)
Results
- 📊 Pain response by SPIN score
- 📊 Pivotal ph2 overall response: 53% (95% CI 42-64%)
- 📐 Multivariate predictors: no prior neurotoxic chemo (OR 5.1, p=0.009); baseline pain >6 (OR 1.8, p=0.003)
- 📐 Optimism-corrected AUC 0.714 (bootstrap 500 iterations)
- 📐 Pain threshold dose-response: >6 optimal (65.8%); >7 (83.3%); >8 (85.7%)
Critique
- ⚠️ Post-hoc design; internal validation only; external validation required before clinical use
- ⚠️ SPIN-2 subgroup N=19; response estimate imprecise
Open questions
- External validation before clinical implementation
- Applicability to non-pancreatic retroperitoneal malignancies
- How early before neurotoxic chemo should SRS be offered?
📚 Sources · 🐦 1 tweet
Celiac SRS = convenient, effective tx for intractable pain, but who benefits most?
— Dr. Nina Niu Sanford (@NiuSanford) May 30, 2026
Post-hoc Ph2 analysis identified 2 response predictors (SPIN score): severe baseline pain & no prior neurotoxic chemo.
Supports earlier use before potential chemo neuropathy. #ASCO26 @OncoAlert pic.twitter.com/3qFYU6N1iD