Dr. Bekaii-Saab on Adjuvant Therapy in Pancreatic Cancer

Tanios Bekaii-Saab, MD, medical oncologist, Mayo Clinic, discusses adjuvant therapy in pancreatic cancer.

Physicians know that about 10% to 15% of patients will present with advanced nonmetastatic pancreas cancer in the adjuvant setting. These patients have either resectable, borderline resectable, or locally advanced nonmetastatic disease, says Bekaii-Saab. Most, if not all, of those patients whose tumors are resectable will end up in surgery. About half of patients with borderline resectable tumors will go to surgery, and about 10% to 15% of patients with locally advanced disease will go to surgery.

Based on the ESPAC-4 study, physicians know that capecitabine and gemcitabine should be the standard for patients with resectable disease. In the United States, physicians should probably use lower doses of capecitabine than used in the ESPAC-4 trial by the Europeans because of the history of capecitabine in the United States versus in Europe.

Radiation does not have a defined role yet, explains Bekaii-Saab. There are studies that have reported positive findings, negative findings, and in between. At this point in time, radiation does not seem to have a role, although it is still being explored in the adjuvant setting. Ultimately, patients with very clear resectable disease will receive adjuvant therapy.