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Langenbeck's Archives of Surgery

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01-12-2018 | REVIEW ARTICLE

Neoadjuvant and adjuvant chemotherapy in pancreatic cancer

Authors: Ulla Klaiber, Carl-Stephan Leonhardt, Oliver Strobel, Christine Tjaden, Thilo Hackert, John P. Neoptolemos

Published in: Langenbeck's Archives of Surgery | Issue 8/2018

Abstract

Background

Only 15–20% of patients with pancreatic ductal adenocarcinoma (PDAC) have a resectable tumor at the time of diagnosis. Effective multimodal treatment concepts including neoadjuvant chemotherapy are therefore needed. Following upfront resection, adjuvant chemotherapy has become mandatory to prevent early tumor recurrence.

Purpose

The aim of this article was to summarize existing evidence on neoadjuvant and adjuvant chemotherapy in PDAC with a focus on high-level evidence based on randomized controlled phase III clinical trials.

Results and conclusions

Neoadjuvant chemotherapy represents an emerging concept for borderline resectable and locally advanced PDAC. To date, randomized trials have failed to provide proof-of-concept outcomes, mostly because of failure to achieve recruitment targets. Nevertheless, this approach needs to be further evaluated scientifically as recent data from a large single-arm cohort study showed that neoadjuvant multimodal therapy could achieve a resection rate in the order of 60% of patients with locally advanced PDAC. For patients with a primarily resectable tumor, however, study results remain unconvincing, and therefore, neoadjuvant therapy should not be used routinely outside of a clinical trial. Adjuvant chemotherapy with gemcitabine and capecitabine in unselected patients can double 5-year overall survival to around 30% compared to mono-chemotherapy with either 5-fluorouracil with folinic acid or gemcitabine. In selected patients, adjuvant modified FOLFIRINOX can produce a 5-year survival rate of around 50%. Further potential gains are to be made in the selection of patients for particular therapies based on the transcriptomic and genetic signature of individual tumors.

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Title: Neoadjuvant and adjuvant chemotherapy in pancreatic cancer
Authors: Ulla Klaiber
Carl-Stephan Leonhardt
Oliver Strobel
Christine Tjaden
Thilo Hackert
John P. Neoptolemos
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1724-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neoadjuvant and adjuvant chemotherapy in pancreatic cancer

Abstract

Background

Purpose

Results and conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Purpose

Results and conclusions

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