From the Guidelines
Adjuvant therapy plays a crucial role in improving overall survival in pancreatic cancer patients.
Key Findings
- Adjuvant chemotherapy has been shown to improve disease-free survival, 2-year survival, and overall survival in pancreatic cancer patients, with a significant reduction in the risk of death compared to surgery alone 1.
- The ESPAC-4 trial demonstrated that the combination of gemcitabine and capecitabine improved median survival to 28.0 months, compared to 25.5 months with gemcitabine monotherapy, with a hazard ratio of 0.82 (95% CI, 0.68-0.98; P = .032) 1.
- The CONKO 001 trial also showed significant improvements in disease-free survival and overall survival with the use of postoperative gemcitabine as adjuvant chemotherapy versus observation in resectable pancreatic adenocarcinoma 1.
Adjuvant Therapy Options
- Recommended adjuvant therapy options include gemcitabine alone or in combination with capecitabine, with the combination regimen showing superiority in the ESPAC-4 trial 1.
- Other options, such as 5-FU/leucovorin, have shown no significant difference in overall survival compared to gemcitabine alone 1.
- Participation in clinical trials is encouraged, and adjuvant therapy options may vary depending on prior neoadjuvant therapy and other clinical considerations 1.
From the Research
Role of Adjuvant Therapy in Pancreatic Cancer
The role of adjuvant therapy in pancreatic cancer is a topic of ongoing research and debate. According to various studies, adjuvant therapy can improve survival rates in patients with resected pancreatic cancer.
- Adjuvant chemotherapy has been shown to prolong median overall survival after resection compared to monotherapy with either gemcitabine or 5-fluorouracil/folinic acid 2.
- A meta-analysis of randomized controlled trials found that adjuvant chemotherapy after complete macroscopic resection for cancer of the exocrine pancreas may substantially prolong disease-free survival and cause a moderate increase in overall survival 3.
- The addition of adjuvant chemotherapy after neoadjuvant chemotherapy and surgical resection has been associated with improved survival for patients with low-risk pathology 4.
- Adjuvant chemoradiation has been shown to improve survival in patients with margin-positive pancreatic cancer, particularly in those with node-negative and node-positive disease 5.
- The European Study Group for Pancreatic Cancer (ESPAC) 1 trial found a survival benefit for adjuvant chemotherapy, but not for adjuvant chemoradiotherapy 6.
Benefits of Adjuvant Therapy
The benefits of adjuvant therapy in pancreatic cancer include:
- Improved overall survival rates 3, 4, 2, 5, 6
- Prolonged disease-free survival 3, 2
- Improved median survival time 3, 2, 5
- Increased 5-year survival rate 3, 6
Optimal Adjuvant Therapy Regimen
The optimal adjuvant therapy regimen for pancreatic cancer is still being defined.
- Combination chemotherapy with gemcitabine and capecitabine has been shown to significantly prolong median overall survival after resection compared to monotherapy with either gemcitabine or 5-fluorouracil/folinic acid 2.
- Adjuvant poly-agent chemotherapy with modified FOLFIRINOX has been shown to achieve median survival times of 54.4 months in selected patients 2.
- Adjuvant chemoradiation has been shown to improve survival in patients with margin-positive pancreatic cancer, particularly in those with node-negative and node-positive disease 5.