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EMT and Stemness—Key Players in Pancreatic Cancer Stem Cells
Open AccessReview

Is There a Standard Adjuvant Therapy for Resected Pancreatic Cancer?

1
Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3.95, 10060 Candiolo (TO), Italy
2
Department of Oncology, University of Turin Medical School, Strada Provinciale 142, km 3.95, 10060 Candiolo (TO), Italy
3
Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3.95, 10060 Candiolo (TO), Italy
4
Department of Oncology, Azienda Sanitaria Locale di Biella, 13875 Ponderano (BI), Italy
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(10), 1547; https://doi.org/10.3390/cancers11101547
Received: 16 September 2019 / Revised: 7 October 2019 / Accepted: 11 October 2019 / Published: 12 October 2019
(This article belongs to the Special Issue Advances in Pancreatic Cancer Research)
Surgical resection remains the only treatment that offers a potential chance of long-term survival. Unfortunately, about 80% of patients treated with curative intent will develop recurrence. Since 2001, adjuvant therapy with gemcitabine or 5-fluorouracyle was recommended. This approach allows a median overall survival (OS) of around 23 months, and 5-year survival of 22%. In recent years, two phase-3 trials investigating new chemotherapy regimens resulted in considerably improved survival times. The doublet gemcitabine–capecitabine has shown improvement in OS from 25.5 to 28 months (p = 0.032) compared to gemcitabine, in the ESPAC-4 trial. Later, preliminary results of PRODIGE 24 trial presented at the 2018 ASCO meeting showed a superiority of a combination chemotherapy regimen with fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) when compared to gemcitabine alone, both in terms of median disease-free survival (21.6 vs. 12.8 months, p < 0.0001) and OS (54.4 vs. 35 months, p = 0.003). Contrary to chemotherapy, the role of adjuvant radiotherapy is still controversial, even in the case of R1 surgery. A randomized trial exploring the role of chemoradiotherapy in this setting is now ongoing in the US (RTOG-0848). Overall, the management of localized pancreatic adenocarcinoma is evolving. In this review, we summarize the current status and the most up-to-date developments in adjuvant treatment.
Keywords: adjuvant chemotherapy; adjuvant chemoradiation; pancreatic ductal carcinoma; capecitabine; gemcitabine; mFOLFIRINOX adjuvant chemotherapy; adjuvant chemoradiation; pancreatic ductal carcinoma; capecitabine; gemcitabine; mFOLFIRINOX
MDPI and ACS Style

Fenocchio, E.; Filippi, R.; Lombardi, P.; Quarà, V.; Milanesio, M.; Aimar, G.; Leone, F.; Aglietta, M. Is There a Standard Adjuvant Therapy for Resected Pancreatic Cancer? Cancers 2019, 11, 1547.

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