Hépato-Gastro & Oncologie Digestive


Adjuvant treatment of pancreatic cancer in 2009 Volume 16, issue 6, novembre-décembre 2009


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Département d’oncologie médicale, Centre régional de lutte contre le cancer GF-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon cedex, France

Pancreatic cancer has benefited from significant advances in diagnosis, assessment of tumor extension and management. Surgical resection remains the cornerstone of any treatment with curative intent. Even though post-resection prognosis is still poor, with a 15 to 20 months median survival time that has not changed for the last 20 years, 5-year survival rates of 10%, and up to 30% in cases without lymph node involvement, can be obtained thanks to a better selection of patients and a reduction in operative morbidity and mortality. Randomized trials failed to show any benefit for adjuvant radiation and adjuvant 5FU-based chemoradiation. The ESPAC-1 trial showed a benefit for 5FU-based adjuvant chemotherapy and the CONKO-001 trial showed a significant disease-free and overall survival benefit for adjuvant gemcitabine. In actual practice, adjuvant chemotherapy with gemcitabine has become in 2009 the standard treatment after surgical resection of pancreatic adenocarcinomas, whatever the stage (with or without resection margin involvement or lymph node involvement). If combined treatments with more active drugs or targeted therapies show a benefit for metastatic cancers, they will have to be evaluated in an adjuvant setting in order to improve these significant but modest results.