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Should Adjuvant Therapy Remain the Standard of Care for Patients With Resected Adenocarcinoma of the Pancreas?

From the Departments of Surgical Oncology (QDC, HOD, JFG) and Medical Oncology (NK, MMJ), Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York.

Correspondence: Address correspondence and reprint requests to: John F. Gibbs, MD, Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263; Fax: 716-845-2320; E-mail: john.gibbs{at}roswellpark.org

ABSTRACT

Adenocarcinoma of the pancreas continues to be a formidable disease. In the United States, patients who have had resected disease are generally offered adjuvant chemoradiation. The current National Comprehensive Cancer Network practice guidelines uniformly support this practice. We reviewed seven selected series to evaluate the efficacy of adjuvant therapy for patients who had resected adenocarcinoma of the pancreas. Current evidence-based analysis demonstrates that an adjuvant therapy regimen as a standard of care is lacking. We, therefore, believe that it should be used judiciously because its benefit is confined to only a fraction of patients treated by complete resection (R0); patients with residual microscopic disease (R1) derived negligible benefits. Given the financial constraints and the small effect that current therapies have on this fatal disease, clinicians should concentrate on developing novel therapies and new paradigms to address this age-old problem.

Key Words: Pancreatic adenocarcinoma • Adjuvant therapy • GITSG trials • EORTC trial • ESPAC-1 trial • Norwegian trial

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