Treatment
Recommendation 3.3
➤ If preoperative therapy is administered, a complete restaging
evaluation is recommended after completion of treatment and
before final surgical planning. (Strong Recommendation; IC-B-I)
Recommendation 4.1
➤ UPDATED. All patients with resected pancreatic adenocarcinoma
who did not receive preoperative therapy should be offered 6
months of adjuvant chemotherapy in the absence of medical or
surgical contraindications. The modified combination regimen
of 5FU, oxaliplatin and irinotecan (mFOLFIRINOX) as used in
the latter part of the PRODIGE 24/CCTG PA.6 trial (oxaliplatin
85 mg/m², leucovorin 400 mg/m², irinotecan 150 mg/m
2
D1,
and 5-FU 2.4 g/m² over 46 h every 14 days for 12 cycles) is
preferred in the absence of concerns for toxicity or tolerance;
alternatively, doublet therapy with gemcitabine and capecitabine
or monotherapy with gemcitabine alone or fluorouracil plus folinic
acid alone can be offered. (Strong Recommendation; EB-B-H).
Recommendation 4.2
➤ Adjuvant chemoradiation may be offered to patients who did
not receive preoperative therapy and present post-resection
with microscopically positive margins (R1) and/or node-positive
disease after completion of 4 to 6 months of systemic adjuvant
chemotherapy as outlined in 4.1. There is clinical equipoise
regarding the benefit of adjuvant radiation therapy in this setting
pending results of an ongoing international RCT. (Moderate
Recommendation; IC-B-I)
Recommendation 4.3
➤ For patients with pancreatic cancer who received preoperative
therapy, there are no RCT data to guide the administration of
postoperative therapy. The Panel recommends that a total of
6 months of adjuvant therapy (including preoperative regimen)
be offered based on extrapolation from adjuvant therapy trials.
(Strong Recommendation; IC-B-L)
