Adjuvant Chemotherapy in Pancreatic Cancer Article Swipe
Kulbir Mann
,
Robert Jones
,
Paula Ghaneh
,
John P. Neoptolemos
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/9781119876007.ch148
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/9781119876007.ch148
Pancreatic ductal adenocarcinoma is likely to become the second leading cause of cancer mortality within the next decade. There have been some improvements in diagnosis and treatments, but there is still much work to be done. This chapter reviews the pertinent adjuvant therapy trials of chemotherapy and radiotherapy in pancreatic cancer and how they have changed practice. Initially, the ESPAC-1 trial demonstrated increased survival with adjuvant 5-fluorouracil (5-FU) and this became standard of care. ESPAC-3 compared 5-FU with gemcitabine; although there was no significant survival difference, the improved toxicity profile meant that gemcitabine was then standard of care. Further improvements have been demonstrated using combination chemotherapy. The ESPAC-4 trial demonstrated a survival benefit for gemcitabine plus capecitabine. The PRODIGE trial employed the multidrug regimen FOLFIRINOX and demonstrated significant increase in median overall survival. The combination of gemcitabine plus nab-paclitaxel in the APACT study did not reach the primary outcome measure of disease-free survival. Future trials are refining chemotherapy agents as the morbidity profile for a four-drug chemotherapy regimen may be so significant that not everyone can have the treatment. The ESPAC-6 adjuvant therapy trial will utilize a signature panel, expressed in the resected tumor, that stratifies patients into gemcitabine- or oxaliplatin-based regimens. The last two decades have seen survival in resectable pancreatic cancer increase from 20 months to 54 months with the use of multidrug chemotherapy agents and now a shift towards biomarkers and stratification of patients. This chapter also reviews the pertinent phase III trials in patients with advanced pancreatic cancer, to determine second-line agents. Currently, the recommended agents are 5-FU combined with folinic acid and liposomal irinotecan, though this has not been trialed in an adjuvant setting in patients with resectable disease.
Related Topics
Concepts
Gemcitabine
Medicine
Oncology
FOLFIRINOX
Internal medicine
Oxaliplatin
Pancreatic cancer
Regimen
Capecitabine
Chemotherapy
Adjuvant therapy
Cancer
Colorectal cancer
Metadata
- Type
- other
- Language
- en
- Landing Page
- https://doi.org/10.1002/9781119876007.ch148
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781119876007.ch148
- OA Status
- gold
- References
- 48
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
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https://doi.org/10.1002/9781119876007.ch148Digital Object Identifier
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Adjuvant Chemotherapy in Pancreatic CancerWork title
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otherOpenAlex work type
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enPrimary language
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2023Year of publication
- Publication date
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2023-08-04Full publication date if available
- Authors
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Kulbir Mann, Robert Jones, Paula Ghaneh, John P. NeoptolemosList of authors in order
- Landing page
-
https://doi.org/10.1002/9781119876007.ch148Publisher landing page
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781119876007.ch148Direct link to full text PDF
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goldOpen access status per OpenAlex
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781119876007.ch148Direct OA link when available
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0Total citation count in OpenAlex
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