2021 Volume 36 Issue 1 Pages 12-19
Enormous progress has been made in the development and standardization of adjuvant therapy regimens for patients with resected pancreatic ductal adenocarcinoma. Several randomized controlled trials clearly showed superiority of adjuvant chemotherapy over no chemotherapy. Adjuvant therapy with gemcitabine is considered indispensable since the results of the CONKO-001 trial. In Japan, JASPAC-01 showed that post-operative adjuvant chemotherapy with S-1 significantly extended overall survival compared with gemcitabine alone. In western countries, the ESPAC-4 trial showed significantly longer median overall survival after combination chemotherapy with gemcitabine plus capecitabine compared with gemcitabine monotherapy, and most recently, results from a multicenter French-Canadian randomized controlled trial showed considerably longer survival after adjuvant modified FOLFIRINOX compared with gemcitabine alone. These chemotherapy regimens are considered to be standard adjuvant therapy in western countries. The question remains as to whether these more aggressive regimens will be feasible in patients with reduced performance status, older age and more advanced disease. Accrual of the trials and follow-up data must be awaited.
