Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

Abstract

Adjuvant chemotherapy is currently used in all patients with resected pancreatic cancer who are able to begin treatment within 3 months after surgery. Since the recent publication of the PRODIGE 24 trial results, modified FOLFIRINOX has become the standard-of-care in the non-Asian population with localized pancreatic adenocarcinoma following surgery. Nevertheless, there is still a risk of toxicity, and feasibility may be limited in heavily pre-treated patients. In more frail patients, gemcitabine-based chemotherapy remains a suitable option, for example gemcitabine or 5FU in monotherapy. In Asia, although S1-based chemotherapy is the standard of care it is not readily available outside Asia and data are lacking in non-Asiatic patients. In patients in whom resection is not initially possible, intensified schemes such as FOLFIRINOX or gemcitabine-nabpaclitaxel have been confirmed as options to enhance the response rate and resectability, promoting research in adjuvant therapy. In particular, should oncologists prescribe adjuvant treatment after a long sequence of chemotherapy +/– chemoradiotherapy and surgery? Should oncologists consider the response rate, the R0 resection rate alone, or the initial chemotherapy regimen? And finally, should they take into consideration the duration of the entire sequence, or the presence of limited toxicities of induction treatment? The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients.

Preoperative CTC-Detection by CellSearch® Is Associated with Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer

“…While of interest for the subsequent handling of the individual patient after surgery, the clinical utility of this score may be limited by the lack of impact on preoperative decisions. Concerning adjuvant treatment, there has been progress in recent years driven by advances in chemotherapy regimens [ 42 ]. Further personalisation by CTC-based risk assessment would be an avenue to future improvement.…”

Application of Mass Spectrometry in Pancreatic Cancer Translational Research

“…Notably, a group of biomarkers is gradually changing the diagnostic value of a single marker for PC. (2) The data and information obtained from MS are highly complex, and require comprehensive biological and functional annotation tools. A more stable bridge must be constructed by a wide range of scientists.…”

Expanding the Spectrum of Pancreatic Cancers Responsive to Vesicular Stomatitis Virus-Based Oncolytic Virotherapy: Challenges and Solutions

“…Gemcitabine (dFdC) is an analog of deoxycytidine and a pro-drug that, once transported into the cell, must be phosphorylated by cellular deoxycytidine kinase to gemcitabine diphosphate (dFdCTP) and gemcitabine triphosphate (dFdCTP), both of which can inhibit processes required for DNA synthesis. Other commonly used chemotherapies for pancreatic cancer include 5-fluorouracil (5-FU), oxaliplatin, albumin-bound paclitaxel, capecitabine, cisplatin, irinotecan, and docetaxel [ 15 , 16 ]. Although several gemcitabine-based combination treatments exist, most have not considerably improved survival.…”