2017 Guideline Update on Potentially Curable Pancreatic Cancer Calls for Two-Drug Therapy

2017 Guideline Update on Potentially Curable Pancreatic Cancer Calls for Two-Drug Therapy

Dr. Matthew H. G. Katz
Dr. Alok Khorana, credit Todd Buchanan
Patients with potentially curable pancreatic cancer should be treated with two medications—gemcitabine and capecitabine—after tumor resection, as long as there are no concerns about toxicity and chemotherapy, according to a newly released ASCO guideline update.

The guideline update has been revised for 2017 on the basis of initial ESPAC-4 data presented during the 2016 ASCO Annual Meeting by John P. Neoptolemos, MD, FRCS, FMedSci, of the University of Liverpool.1 Full study results were subsequently published in Lancet.2 

“Very soon after last year’s guidelines came out—which were ASCO’s first guidelines on potentially curable pancreatic cancer—a new study was presented during the Annual Meeting that directly addressed a two-drug combination versus a single-drug treatment that had been the standard thus far,” said Alok Khorana, MD, of the Cleveland Clinic Foundation, and co-chair of the 2017 guideline update. “There were better outcomes with the doublet versus with the single agent.”

In the ESPAC-4 trial, 730 patients in 92 hospitals in England, Scotland, Wales, Germany, France, and Sweden were enrolled. Of these, 366 patients were randomly assigned to receive gemcitabine, and 364 were randomly assigned to receive gemcitabine plus capecitabine. The study was published early because survival rates were higher in the dual-drug group: Patients treated with both medications survived a median of 28 months compared with a median of 25.5 months for those treated with one drug.

The guideline update on potentially curable pancreatic cancer improves upon information announced just a year ago about how oncologists can best treat pancreatic cancer after resection. “The rest of the guideline is unchanged,” said Matthew H. G. Katz, MD, FACS, of The University of Texas MD Anderson Cancer Center, and guidelines panel co-chair. “We thought the clinical significance of these data was sufficient and significant enough to warrant an update to the current guidelines.”

The findings introduce a new standard of care with the doublet regimen in patients who have resectable pancreatic cancer—approximately 20% of those diagnosed with this kind of cancer, Dr. Khorana said. “It’s great [news] for patients with pancreatic cancer—you really can’t find a better outcome,” he said.

Pancreatic cancer is expected to become the second-leading cancer-related cause of death by the year 2030—an increase from its present fifth-place standing, Dr. Khorana said.

“Pancreatic cancer is very difficult to treat,” Dr. Khorana said. “There is still a lot of work to be done, and we still need funding to do it.”  

–Cheryl Alkon


  1. Neoptolemos JP, et al. J Clin Oncol. 2016;34 (suppl; abstr LBA4006).
  2. Neoptolemos JP, et al. Lancet. 2017;389:1011-24.