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Questions Remain in Localized Pancreatic Cancer as More Treatment Modalities Emerge

Kristi Rosa
Published: Friday, Jan 10, 2020

Pablo Ferraro, MD, a medical oncologist at Memorial Cancer Institute of Memorial Healthcare System

Pablo Ferraro, MD

Findings from 3 key trials have shed light on how to approach neoadjuvant and adjuvant treatment for patients with pancreatic cancer, according to Pablo Ferraro, MD, but pivotal questions regarding disease biology and the potential role of emerging modalities in the paradigm have yet to be answered.

In the neoadjuvant setting, data from the phase III PREOPANC-1 trial showed that the combination of preoperative chemotherapy and radiation led to a better survival benefit in patients with resectable or borderline resectable disease compared with immediate surgery.1 Chemoradiotherapy led to a median overall survival (OS) of 17.1 months versus 13.7 months with immediate surgery followed by adjuvant chemotherapy in the intent-to-treat patient population (HR, 0.74; P = .074).

In the phase III PRODIGE 24/CCTG PA.6 trial, data demonstrated that adjuvant treatment with modified FOLFIRINOX resulted in significantly longer survival compared with gemcitabine in patients with resected pancreatic cancer. Median OS in the FOLFIRINOX arm was 54.4 months versus 35.0 months in the gemcitabine arm, translating to a 36% reduction in the risk of death (HR, 0.64; 95% CI, 0.48-0.86; P =.003).2 Based on these pivotal data, modified FOLFIRINOX emerged as the new standard of care in this setting.

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