S-1: changing the facets of adjuvant chemotherapy in pancreatic cancer?

From an oncologists view the treatment progress in curatively resected patients for pancreatic cancer (PDAC) has been frustrating so far. Although, the implementations of new standard of care chemotherapies in metastatic PDAC such as FOLFIRINOX (1) or Gemcitabine/Nab-Paclictaxel were a great advancement (2), adjuvant treatment efforts remained static. The use of adjuvant therapy is recommended by several medical societies (3-5) and is based on numerous trials: the CONKO-001 (6), ESPAC-1 (7) and ESPAC-3 (8) trials defined to start gemcitabine or infusional 5-FU monotherapy as the standard of care within 12 weeks post-operative, only differing in their respective toxicity profiles. These regimens have been a breakthrough at the time. However, novel and more tailored treatment algorithms are warranted to eventually reach a high response rate in only a subset of PDAC patients as “one pill fits all” seems to be an updated goal in PDAC.