Adjuvant Chemotherapy in Pancreatic Cancer View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2010

AUTHORS

Paula Ghaneh , John P. Neoptolemos , David Cunningham

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 in the liver. Adjuvant therapy has been employed in large randomized trials to treat systemic disease and hopefully improve the poor prognosis. Chemoradiation, chemotherapy using either 5-fluorouracil/folinic acid (5FU/FA) or gemcitabine 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 recent 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 based on the results from the ESPAC-1 study. Gemcitabine also confers a disease free survival advantage when given as adjuvant therapy in patients who have undergone pancreatic resection. The survival advantage associated with chemotherapy is supported by an individual patient data meta-analysis and further meta-analyses.The accumulation of level 1 evidence has now confirmed that the standard of care for adjuvant therapy is post operative chemotherapy using either 5FU/FA or gemcitabine. Ongoing trials will address which agents are the most effective and which patients will benefit the most. More... »

PAGES

1051-1077

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-0-387-77498-5_43

DOI

http://dx.doi.org/10.1007/978-0-387-77498-5_43

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1041488623


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