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Open AccessReview

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

1
UMR9020-UMR-S 1277 Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000 Lille, France
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Medical Oncology Department, CHU Lille, University of Lille, F-59000 Lille, France
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Department of Digestive Surgery and Transplantation, Lille University Hospital, F-59000 Lille, France
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Department of Hepatogastroenterology and GI Oncology, La Pitié-Salpêtrière Hospital, INSERM UMRS 1138, Université de Paris, F-75013 Paris, France
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Department of Digestive, Oncological, and Transplant Surgery, Paul Brousse Hospital, Paris-Saclay University, F-94800 Villejuif, France
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Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, F-76100 Rouen, France
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Service d’Oncologie Digestive et Médicale, Hôpital Paul Brousse (AP-HP), 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(12), 3866; https://doi.org/10.3390/cancers12123866
Received: 29 November 2020 / Revised: 18 December 2020 / Accepted: 19 December 2020 / Published: 21 December 2020
(This article belongs to the Special Issue Recent Advances in Pancreatic Ductal Adenocarcinoma)
In operated pancreatic cancer patients who are able to begin treatment within 3 months after surgery, adjuvant chemotherapy is currently used to limit disease recurrence but questions remain for the clinician. Recently, modified FOLFIRINOX has become the standard-of-care in the non-Asian population, nevertheless there is still a risk of toxicity and feasibility may be limited in heavily pre-treated patients. Gemcitabine-Nabpaclitaxel, Gemcitabine alone in non-Asian patients are alternatives to be discussed. In Asia, S1-based chemotherapy remains the standard. The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients.
Adjuvant chemotherapy is currently used in all patients with resected pancreatic cancer who are able to begin treatment within 3 months after surgery. Since the recent publication of the PRODIGE 24 trial results, modified FOLFIRINOX has become the standard-of-care in the non-Asian population with localized pancreatic adenocarcinoma following surgery. Nevertheless, there is still a risk of toxicity, and feasibility may be limited in heavily pre-treated patients. In more frail patients, gemcitabine-based chemotherapy remains a suitable option, for example gemcitabine or 5FU in monotherapy. In Asia, although S1-based chemotherapy is the standard of care it is not readily available outside Asia and data are lacking in non-Asiatic patients. In patients in whom resection is not initially possible, intensified schemes such as FOLFIRINOX or gemcitabine-nabpaclitaxel have been confirmed as options to enhance the response rate and resectability, promoting research in adjuvant therapy. In particular, should oncologists prescribe adjuvant treatment after a long sequence of chemotherapy +/– chemoradiotherapy and surgery? Should oncologists consider the response rate, the R0 resection rate alone, or the initial chemotherapy regimen? And finally, should they take into consideration the duration of the entire sequence, or the presence of limited toxicities of induction treatment? The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients. View Full-Text
Keywords: pancreatic cancer; adjuvant therapy; neoadjuvant therapy; biomarkers; precision medicine; timing pancreatic cancer; adjuvant therapy; neoadjuvant therapy; biomarkers; precision medicine; timing
MDPI and ACS Style

Turpin, A.; el Amrani, M.; Bachet, J.-B.; Pietrasz, D.; Schwarz, L.; Hammel, P. Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021. Cancers 2020, 12, 3866. https://doi.org/10.3390/cancers12123866

AMA Style

Turpin A, el Amrani M, Bachet J-B, Pietrasz D, Schwarz L, Hammel P. Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021. Cancers. 2020; 12(12):3866. https://doi.org/10.3390/cancers12123866

Chicago/Turabian Style

Turpin, Anthony; el Amrani, Mehdi; Bachet, Jean-Baptiste; Pietrasz, Daniel; Schwarz, Lilian; Hammel, Pascal. 2020. "Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021" Cancers 12, no. 12: 3866. https://doi.org/10.3390/cancers12123866

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Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

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