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October 7, 2021

Adjuvant Chemotherapy for Stage I Pancreatic Ductal Adenocarcinoma—Is It Based on Evidence or Clinical Wisdom?

Author Affiliations
  • 1Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
  • 2Molecular Medicine Program, University of Pavia, Pavia, Italy
  • 3Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
JAMA Oncol. 2021;7(12):1759-1760. doi:10.1001/jamaoncol.2021.3603

According to the World Health Organization Global Cancer Observatory,1 more than 140 000 new exocrine pancreatic cancers are diagnosed in Europe annually, with most originating in the ducts (pancreatic ductal adenocarcinoma [PDAC]). Surgery can be curative, but only 15% to 20% of cases are resectable at the time of diagnosis. However, even after radical resection, the prognosis is poor, with a 5-year overall survival (OS) rate of less than 20%. Because of the high rate of recurrence, several randomized clinical trials (RCTs) investigated the role of adjuvant chemotherapy, radiotherapy, or combined treatment. These studies demonstrated a survival benefit for adjuvant chemotherapy. Currently, adjuvant mFOLFIRINOX or gemcitabine is recommended regimens for patients with PDAC who have undergone resection who did not receive neoadjuvant treatment, including pathological stages IA and IB (pT1N0 or pT2 N0).2

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