Perioperative treatment options in resectable pancreatic cancer - how to improve long-term survival

Table 1 Standard adjuvant therapy

Gemcitabine 1000 mg/m2i.v. 30 min	d1, 8, 15, q29
	6 cycles
5-flourouracil 425 mg/m2i.v. Bolus	d1-5, q29
Folinic acid 20 mg/m2i.v. Bolus	6 cycles

Table 2 Completed adjuvant phase III trials

Ref.	Treatment group	Median OS (mo)	3-yr-survival	5-yr-survival
CONKO-001[38,39]	Gem	22.8	37%	21%
	Observation	20.2	20%	9%
ESPAC-3[40]	Gem	23.6
	5-FU/folinsäure	23.0
JASPAC-01[43]	S1		2 yr 70%
	Gem		2 yr 53%
RTOG 97-04	RCT + Gem	20.5	31%	24%
(pancreatic head)[57]	RCT + 5-FU/FS	16.9	22%	11%
CONKO-005[45]	Gem + Erlotinib	24.6	36%	28%
	Gem	26.5	33%	19%

5-FU: 5-flourouracil; OS: Overall survival.

Table 3 Ongoing adjuvant trials

Trial	Registration No.	Treatment groups	Patients planned
ESPAC-4	ISRCTN96397434	Gem + capecitabine	732
		Gem
APACT	NCT01964430	Gem + nab-paclitaxel	800
		Gem
ACCORD24	NCT01526135	FOLFIRINOX	490
		Gem
RTOG-0848	NCT01013649	Gem + RCT (capecitabine or 5-FU)	950
		Gem
Algenpantucel Immunotherapy	NCT01072981	Gem ± RCT + Algenpantucel-I vaccine	722
		Gem ± RCT

5-FU: 5-flourouracil; RCT: Randomized controlled trial.

Table 4 Ongoing neoadjuvant/borderline resectable trials

Trial	Registration No.	Treatment groups	Primary endpoint	Patients planned
NEONAX	NCT02047513	2 cycles Gem + nab-paclitaxel neoadjuvant	DFS	166
		4 cycles Gem + nab-paclitaxel adjuvant
		6 cycles Gem + nab-paclitaxel adjuvant
Perioperative mFOLFIRINOX	NCT02047474	3 cycles FOLFORINOX	DFS	46
		Neoadjuvant + adjuvant
NEOLAP	NCT02125136	2 cycles Gem + nab-paclitaxel	Conversion rate	168
		+ 2 × FOLFIRINOX		(including locally advanced PDAC)
		+ adjuvant 3 × Gem + nab-paclitaxel
		4 cycles Gem + nab-paclitaxel
		+ adjuvant 3 × Gem + nab-paclitaxel

DFS: Disease-free survival; PDAC: Pancreatic ductal adenocarcinomas.