, Volume 18, Issue 5, pp 1224-1228
Date: 08 Mar 2011

Adjuvant Therapy for Pancreatic Cancer: A Logical Strategy in Search of Progress

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In this issue of Annals of Surgical Oncology, Regine et al.1 report the long-term results of the U.S. Intergroup/RTOG 9704 phase III trial of adjuvant therapy for surgically resected adenocarcinoma of the pancreas. In contrast to their initial analysis, they found no difference in survival between patients treated with either gemcitabine or 5-fluorouracil (5-FU) delivered before and after 5-FU-based chemoradiation.1,2 They offer the following possible explanations for the failure of the gemcitabine arm to be associated with a survival advantage: the frequent use of salvage gemcitabine therapy at the time of recurrence in those patients randomized to 5-FU; more advanced local disease (T3/T4) in the gemcitabine arm; the sequencing of chemoradiation, which interrupted potentially effective systemic therapy (rather than a chemotherapy followed by a chemoradiation sequencing strategy); and the delivery of only four cycles of gemcitabine rather than six, as in the CONKO-001 trial.3 Although ...