Adjuvant Therapy for Pancreatic Cancer: A Logical Strategy in Search of Progress
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 ...
- Regine WF, Winter KA, Abrams R, et al. Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the US Intergroup/RTOG 9704 phase III Trial. Ann Surg Oncol. doi:10.1245/s10434-011-1630-6.
- Regine W, Winter K, Abrams R, et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma. J Am Med Assoc. 2008; 299:1019–26. CrossRef
- Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA. 2007;297:267–77. CrossRef
- Neoptolemos J, Stocken D, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection. JAMA. 2010;304:1073–81. CrossRef
- Van Laethem J, Hammel P, Mornex F, et al. Adjuvant gemcitabine alone versus gemcitabine based chemoradiotherapy after curative resection for pancreatic cancer: A randomized EORTC-40013–22012/FFCD-9203/GERCOR phase II study. J Clin Oncol. 2010;28:4450–6. CrossRef
- Herman J, Swartz, Hsu C, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: Results of a large, prospectively collected database and the Johns Hopkins Hospital. J Clin Oncol. 2008;26:3503–10. CrossRef
- Simons J, Chau Ng S, McDade T, et al. (2010) Progress for resectable cancer? A population-based assessment of US practices. Cancer 116: 2503.
- Wolff R, Varadhachary G, Evans D. Adjuvant therapy for adenocarcinoma of the pancreas: Analysis of reported trials and recommendations for future progress. Ann Surg Oncol. 2008;15:2773–86. CrossRef
- Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A III, editors. American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag; 2010; 24:241–9.
- Katz MH, Merchant N, Brower S, et al. Standardization of surgical and pathologic variables is needed in multicenter trials of adjuvant therapy for pancreatic cancer results from the ACOSOG Z5031 trial. Ann Surg Oncol. 2010;18:337–44. CrossRef
- Iacobuzio-Donahue C, Fu B, Yachida S, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 2009;27:1806–13. CrossRef
- Evans D, Varadhachary G, Crane C, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502. CrossRef
- Varadhachary G, Wolff R, Evans D, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3487–95. CrossRef
- US National Institutes of Health. Gemcitabine hydrochloride with or without erlotinib hydrochloride followed by the same chemotherapy regimen with or without radiation therapy and capecitabine or fluorouracil in treating patients with pancreatic cancer that has been removed by surgery. February 15, 2011. http://www.clinicaltrials.gov/ct2/show/NCT01013649?term=Pancreatic+Cancer+and+RTOG&rank=6.
- Adjuvant Therapy for Pancreatic Cancer: A Logical Strategy in Search of Progress
Annals of Surgical Oncology
Volume 18, Issue 5 , pp 1224-1228
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