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Adjuvant Chemotherapy in Pancreatic Cancer

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Pancreatic Cancer

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Abstract

Pancreatic cancer is one of the major causes of cancer death. Most patients present with advanced disease, and only 10–15% of patients can undergo resection. Survival after curative surgery is poor, as recurrences occur either locally or distantly. Adjuvant therapy has been employed in large randomized trials to treat systemic disease and hopefully improve the poor prognosis. Chemoradiation, chemotherapy using 5-fluorouracil/folinic acid (5FU/FA), S-1, gemcitabine or gemcitabine plus capecitabine, and combination therapy have all been used in the adjuvant setting.

The results of the EORTC and ESPAC-1 trials have revealed that there is no survival advantage associated with adjuvant chemoradiation following resection for pancreatic cancer compared to no chemoradiation. There is no level 1 evidence, as yet that chemoradiation is superior to chemotherapy alone following surgery. Justification for the use of combination chemoradiation with follow-on chemotherapy is based on the results of an underpowered 1987 GITSG study, which closed prematurely and compared intervention to observation. The RTOG 9704 combination study did not demonstrate a survival difference between a 5FU-based regimen compared with a gemcitabine-based chemoradiation regimen. There is no completed randomized study comparing chemotherapy versus combination therapy.

There is a clear survival advantage with adjuvant 5FU/FA and single-agent gemcitabine based on the results from the ESPAC-1 and CONKO-001 study, respectively. The ESPAC-3 trial showed that these adjuvant regimens are equally effective, but gemcitabine has a better toxicity profile. In contrast, in a Japanese population, the JASPAC-01 trial demonstrated the superiority of S1 over gemcitabine. Adjuvant combination chemotherapy with gemcitabine plus capecitabine has been recently shown to provide a survival advantage compared with gemcitabine alone in Western patients in the ESPAC-4 trial. Phase III studies investigating other combination chemotherapy regimens are ongoing and will possibly increase the number of treatment options in this setting.

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Published Guidelines

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany

    John P. Neoptolemos

  2. Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, UK

    David Cunningham & Francesco Sclafani

  3. Department of Surgery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK

    Paula Ghaneh

  4. Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    Paula Ghaneh

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  1. John P. Neoptolemos
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  2. David Cunningham
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  3. Francesco Sclafani
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  4. Paula Ghaneh
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Corresponding author

Correspondence to John P. Neoptolemos .

Editor information

Editors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos

  2. Division of Research Department of Surgery and Genomic Sciences and Precision Medicine Center (GSPMC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Raul Urrutia

  3. Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler

Section Editor information

  1. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler

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Neoptolemos, J.P., Cunningham, D., Sclafani, F., Ghaneh, P. (2018). Adjuvant Chemotherapy in Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_43

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