The American Society of Clinical Oncology (ASCO) published an update to their pancreatic cancer clinical practice guideline in the Journal of Clinical Oncology, focusing specifically on the adjuvant treatment of R0 or R1 resected disease.1
ASCO uses a signal approach, in which routine literature searches and expertise of panel members are used to identify potentially practice-changing data.
This update was initiated by the publication of results from the phase 3 ESPAC-4 (ClinicalTrials.gov Identifier: NCT00058201) trial that evaluated adjuvant gemcitabine plus capecitabine or gemcitabine only among 730 patients with resected pancreatic ductal adenocarcinoma.
The chemotherapy doublet significantly prolonged overall survival to 28.0 months (95% CI, 23.5-31.5 months) from 25.5 months (95% CI, 22.7-27.9 months) with gemcitabine monotherapy (hazard ratio, 0.82; 95% CI, 0.68-0.98; P = .032).
“Substantial randomized trial evidence establishes the benefit of adjuvant systemic therapy in this setting,” wrote the authors.
The updated ASCO recommendation is that all patients with resected disease who did not undergo preoperative treatment be offered 6 months of gemcitabine plus capecitabine. Patients who are ineligible or unable to tolerate this regimen can be offered gemcitabine monotherapy or fluorouracil plus folinic acid.
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Adjuvant chemotherapy should be initiated within 8 weeks of surgical resection, according to ASCO.
This is the only change to ASCO’s 2016 clinical practice guideline for pancreatic cancer.
- Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017 Apr 11. doi: 10.1200/JCO.2017.72.4948 [Epub ahead of print]