Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant and neoadjuvant approaches to treat surgically resectable pancreatic cancer

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Adjuvant therapy for pancreatic cancer is currently a controversial topic. Very little is known about the potential components of adjuvant therapy. All published randomized trials evaluating adjuvant therapy for pancreatic cancer have limitations that prevent the establishment of an absolute “standard of care.” However, with the recent report of Charite Onkologie Clinical Studies in Gastrointestinal Cancer in abstract form and European Study Group for Pancreatic Cancer-1, it is clear that chemotherapy has an effect as adjuvant therapy. The role of radiation remains unclear. The future of adjuvant therapy is dependent on the investigators designing better trials that answer the important remaining questions: the role of radiation therapy, the integration of newer agents, and the best regimen of those currently available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Yang GY, Wagner TD, Fuss M, Thomas CR Jr: Multimodality approaches for pancreatic cancer. CA Cancer J Clin 2005, 55:352–367. A well-written summary of the treatment of pancreatic cancer.

    PubMed  Google Scholar 

  2. Kim J, Czischke K, Brennan M, Conlon K: Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer. J Gastrointest Surg 2002, 6:763–769.

    Article  PubMed  Google Scholar 

  3. Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004, 350:1200–1210. This study represents one of the largest ever conducted in adjuvant therapy of pancreatic cancer. Although it provides important support for chemotherapy, it adds little to the understanding of the role of radiation therapy.

    Article  PubMed  CAS  Google Scholar 

  4. Kalser MH, Ellenberg SS: Pancreatic cancer: adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985, 120:899–903.

    PubMed  CAS  Google Scholar 

  5. Klinkenbijl JH, Jeekel J, Sahmoud T, et al.: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region. Phase III trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group. Ann Surg 1999, 230:776–784.

    Article  PubMed  CAS  Google Scholar 

  6. Neoptolemos JP, Kerr DJ, Beger H, et al.: ESPAC-1 trial progress report: the European randomized adjuvant study comparing radiochemotherapy, 6 months chemotherapy and combination therapy versus observation in pancreatic cancer. Digestion 1997, 58:570–577.

    Article  PubMed  CAS  Google Scholar 

  7. Abrams RA, Lillemoe KD, Plantadosi S: Continuing controversy over adjuvant therapy of pancreatic cancer. Lancet 2001, 358:1565–1566.

    Article  PubMed  CAS  Google Scholar 

  8. Stocken DD, Buchler MW, Dervenis C, et al.: Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005, 92:1372–1381.

    Article  PubMed  CAS  Google Scholar 

  9. Neuhaus P, Oettle H, Post S, et al.: A randomised, prospective, multicenter phase III trial of adjuvant chemotherapy with gemcitabine vs observation in patients with resected pancreatic cancer. Proc Am Soc Clin Oncol 2005, 23:4015.

    Google Scholar 

  10. Picozzi VJ, Kozarek RA, Traverso LW: Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003, 185:476–480.

    Article  PubMed  Google Scholar 

  11. Moore MJ, Goldstein D, Hamm J, et al.: Erlotinib plus gemcitabine compared to gemcitabine alone in patients with advanced pancreatic cancer. A phase III trial of the National Cancer Institute of Canada Clinical Trials Group [NCIC-CTG]. Proc Am Soc Clin Oncol 2005, 23:1.

    Google Scholar 

  12. Xiong HQ, Rosenberg A, LoBuglio A, et al.: Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor, in combination with gemcitabine for advanced pancreatic cancer: a multicenter phase II trial. J Clin Oncol 2004, 22:2610–2616.

    Article  PubMed  CAS  Google Scholar 

  13. Kindler Hl, Friberg G, Singh DA, et al.: Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol 2005, 23:8033–8040.

    Article  PubMed  CAS  Google Scholar 

  14. Yeo C, Cameron J, Sohn T, et al.: Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997, 226:248–257.

    Article  PubMed  CAS  Google Scholar 

  15. Willett C, Lewandrowski K, Warshaw A, et al.: Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993, 217:144–148.

    Article  PubMed  CAS  Google Scholar 

  16. Moutardier V, Turrini O, Huiart L, et al.: A reappraisal of preoperative chemoradiation for localized pancreatic head ductal adenocarcinoma in a 5-year single-institution experience. J Gastrointest Surg 2004, 8:502–510.

    Article  PubMed  CAS  Google Scholar 

  17. Sasson AR, Wetherington RW, Joffman JP, et al.: Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: analysis of histopathology and outcome. Int J Gastrointest Cancer 2003, 34:121–128.

    Article  PubMed  Google Scholar 

  18. Hoffman J, Lipsits S, Pisansky T, et al.: Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, respectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group study. J Clin Oncol 1998, 16:317–323.

    PubMed  CAS  Google Scholar 

  19. Pisters P, Wolff R, Janjan N, et al.: Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: toxicities, histologic response rates, and event-free outcome. J Clin Oncol 2002, 20:2537–2544.

    Article  PubMed  CAS  Google Scholar 

  20. Magnin V, Moutardier V, Giovannini M, et al.: Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer. Int J Radiat Oncol Biol Phys 2003, 55:1300–1304.

    Article  PubMed  Google Scholar 

  21. White R, Tyler D: Neoadjuvant therapy for pancreatic cancer: the Duke experience. Surg Oncol Clin N Am 2004, 13:675–684.

    Article  PubMed  Google Scholar 

  22. Snady H, Bruckner H, Cooperman A, et al.: Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. Cancer 2000, 89:314–327.

    Article  PubMed  CAS  Google Scholar 

  23. Pipas J, Barth R, Zaki B, et al.: Docetaxel/gemcitabine followed by gemcitabine and external beam radiotherapy in patients with pancreatic adenocarcinoma. Ann Surg Oncol 2005, 12:995–1004.

    Article  PubMed  Google Scholar 

  24. Ammori J, Colletti L, Zalupski M, et al.: Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas. J Gastrointest Surg 2003, 7:766–772.

    Article  PubMed  Google Scholar 

  25. Kastl S, Brunner T, Hermann O, et al.: Neoadjuvant radio-chemotherapy in advanced primarily nonresectable carcinomas of the pancreas. Eur J Surg Oncol 2000, 26:578–582.

    Article  PubMed  CAS  Google Scholar 

  26. Cheng T, Sheth K, White R: Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. Ann Surg Oncol 2005, 13:66–74.

    Article  Google Scholar 

  27. Hoffman J, McGinn C, Szarka C, et al.: A phase I study of preoperative gemcitabine with radiation therapy followed by postoperative gemcitabine for patients with localized, resectable pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1998, 17:1090.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vanderbilt University Medical Center, 777 Preston Research Building, 37232, Nashville, TN, USA

    Vicki L. Keedy MD

Authors
  1. Vicki L. Keedy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jordan Berlin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keedy, V.L., Berlin, J. Adjuvant and neoadjuvant approaches to treat surgically resectable pancreatic cancer. Curr. Treat. Options in Oncol. 7, 381–388 (2006). https://doi.org/10.1007/s11864-006-0006-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-006-0006-9

Keywords

Search

Navigation