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Annals of Oncology 14:675-692, 2003
© 2003 European Society for Medical Oncology

Adjuvant therapy in pancreatic cancer: historical and current perspectives

J. P. Neoptolemos1,+, D. Cunningham2, H. Friess3, C. Bassi4, D. D. Stocken5, D. M. Tait2, J. A. Dunn5, C. Dervenis6, F. Lacaine7, H. Hickey1, M. G. T. Raraty1, P. Ghaneh1 and M. W. Büchler3

1 Department of Surgery, University of Liverpool, Liverpool; 2 Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, UK; 3 Department of Surgery, University of Heidelberg, Heidelberg, Germany; 4 Surgical Department, Endocrine and Pancreatic Unit, University of Verona, Italy; 5 CRC Institute for Cancer Studies, Birmingham, UK; 6 Department of Surgery, Agia Olga Hospital, Athens, Greece; 7 Department of Surgery, Hopital Tenon, Paris, France

Received 24 October 2002; revised 3 February 2003; accepted 13 February 2003

Abstract

The results from pancreatic ductal adenocarcinoma appear to be improving with increased resection rates and reduced postoperative mortality reported by specialist pancreatic cancer teams. Developments with medical oncological treatments have been difficult, however, due to the fundamentally aggressive biological nature of pancreatic cancer and its resistance to chemotherapy coupled with a relative dearth of randomised controlled trials. The European Study Group for Pancreatic Cancer (ESPAC)-1 trial recruited nearly 600 patients and is the largest trial in pancreatic cancer. The results demonstrated that the current best adjuvant treatment is chemotherapy using bolus 5-fluorouracil with folinic acid. The median survival of patients randomly assigned to chemoradiotherapy was 15.5 months and is comparable with many other studies, but the median survival in the chemotherapy arm was 19.7 months and is as good or superior to multimodality treatments including intra-operative radiotherapy, adjuvant chemoradiotherapy and neo-adjuvant therapies. The use of adjuvant 5-fluorouracil with folinic acid may be supplanted by gemcitabine but requires confirmation by ongoing clinical trials, notably ESPAC-3, which plans to recruit 990 patients from Europe, Canada and Australasia. Major trials such as ESPAC-1 and ESPAC-3 have set new standards for the development of adjuvant treatment and it is now clear that such treatment in this field has the potential to significantly improve both patient survival and quality of life after curative resection.

Key words: adjuvant therapy, pancreatic cancer, randomised trials


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