Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

Version 1 : Received: 29 November 2020 / Approved: 30 November 2020 / Online: 30 November 2020 (16:45:30 CET)

A peer-reviewed article of this Preprint also exists.

Turpin, A.; el Amrani, M.; Bachet, J.-B.; Pietrasz, D.; Schwarz, L.; Hammel, P. Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021. Cancers 2020, 12, 3866. Turpin, A.; el Amrani, M.; Bachet, J.-B.; Pietrasz, D.; Schwarz, L.; Hammel, P. Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021. Cancers 2020, 12, 3866.

Journal reference: Cancers 2020, 12, 3866
DOI: 10.3390/cancers12123866

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.

Subject Areas

Pancreatic Cancer; Adjuvant therapy; neoadjuvant therapy; biomarkers; Precision medicine; timing

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