- The European Society for Medical Oncology (ESMO) has released an update to its 2015 Clinical Practice Guidelines for the treatment, diagnosis, and follow-up of pancreatic cancer.
Why this matters
- The ESPAC-4 trial (n=732) showed better relapse-free survival (HR, 0.86; P=.082) and OS (HR, 0.82; P=.032) with gemcitabine+capecitabine than with gemcitabine alone.
- The PRODIGE 24/CCTG PA.6 trial showed better DFS (HR, 0.59; 95% CI, 0.47-0.74) and OS (HR, 0.66; 95% CI, 0.49-0.89) with modified (m)FOLFIRINOX than gemcitabine alone, with more grade 3-4 toxicity.
- After pancreatic resection in selected, fit patients, mFOLFIRINOX should be the first choice for adjuvant therapy. This recommendation is based on survival outcomes and the therapy’s toxicity profile.
- Gemcitabine/capecitabine is an alternative for patients who are frail: that is, patients aged >70 years or who have an Eastern Cooperative Oncology Group performance status of 2. It is also available for patients who have any contraindications to drugs used in FOLFIRINOX.
- Gemcitabine alone should be used only in frail patients.