The European Society for Medical Oncology (ESMO) has updated its guidelines on the management of pancreatic cancer to reflect findings from the ESPAC-4 and PRODIGE 24/CCTG PA.6 trials on combined chemotherapy versus gemcitabine alone.
ESMO now recommends that a modified regimen of 5-fluorouracil (5-FU)/irinotecan/oxaliplatin/leucovorin (mFOLFIRINOX) should be the first adjuvant therapeutic option after resection of pancreatic cancer in selected and fit patients.
In more frail patients (age >70 years, Eastern Cooperative Oncology Group performance status 2, or patients with a contraindication to FOLFIRINOX), gemcitabine/capecitabine could be an option.
Gemcitabine alone should be used only in frail patients.
ESPAC-4 included 732 patients ≥18 years of age who had undergone complete macroscopic resection for grade R0 (clear margins) or R1 (microscopic tumour at the margin) ductal adenocarcinoma of the pancreas. Patients were randomised to receive either gemcitabine alone or a combination of gemcitabine and capecitabine. The combination was associated with improved survival in R0 patients.
The PRODIGE 24/CCTG PA.6 trial found that mFOLFIRINOX given after resection of pancreatic cancer significantly improved survival compared with gemcitabine alone.