GASTROINTESTINAL TRACT: Edited by Alain Hendlisz and Francesco SclafaniAdjuvant chemotherapy in pancreatic cancer: state of the art and future perspectivesMas, Léoa; Schwarz, Lilianb,c; Bachet, Jean-Baptistea,d Author Information aDepartment of Hepato-gastroenterology, Groupe Hospitalier Pitié Salpêtrière, Paris bDepartment of Digestive Surgery, Rouen University Hospital cDepartment of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Rouen dSorbonne University, UPMC University, Paris, France Correspondence to Jean-Baptiste Bachet, MD, PhD, Service d’Hépato-astroentérologie et Oncologie Digestive, Groupe Hospitalier Pitié Salpêtrière, 47–83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. Tel: +33 1 42 16 10 41; fax: +33 1 42 16 12 38; e-mail: [email protected] Current Opinion in Oncology: July 2020 - Volume 32 - Issue 4 - p 356-363 doi: 10.1097/CCO.0000000000000639 Buy Metrics Abstract Purpose of review The modalities of management of resectable pancreatic ductal adenocarcinoma (PDAC) have evolved in recent years with new practice guidelines on adjuvant chemotherapy and results of randomized phase III trials. The aim of this review is to describe the state of the art in this setting and to highlight future possible perspectives. Recent findings Resectable PDAC is the tumor without vascular contact or a limited venous contact without vein irregularity. Several pathologic and biologic robust prognostic factors such as an R0 resection defined by a margin at least 1 mm have been validated. In phase III trials, the doublet gemcitabine-capecitabine provided a statistically significant, albeit modest overall survival benefit, but failed to show an improvement in relapse-free survival. Similarly, gemcitabine plus nab-paclitaxel did not increase disease-free survival. Modified FOLFIRINOX led to improved disease-free survival, overall survival, and metastasis-free survival, with acceptable toxicity. In the future, prognostic and/or predictive biomarkers could lead the optimization of therapeutic strategies and neoadjuvant treatment could become a standard of care in PDAC. Summary After curative intent resection, modified FOLFIRINOX is the standard of care in adjuvant in fit patients with PDAC. Others regimens (monotherapy or gemcitabine-based) are an option in unfit patients. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.