ESPAC-1 has established the role of adjuvant systemic chemotherapy in patients with pancreatic cancer after curative-intent resection. Recent observation-controlled studies further demonstrated that 6 months of gemcitabine monotherapy could double the recurrence-free survival, from 5.0-6.7 to 11.4-13.4 months, and reduced risk of death by 23-24% as compared to observation alone. Of interesting to note, the recurrence-free survival of patients receiving gemcitabine monotherapy decreased from 13.4-14.3 months in the CONKO-001 and ESPAC-3 and -4 studies to 11.3-12.8 months in the more recent launched CONKO-005 and PRODIGY 24/CCTG PA.6 studies. However, the median overall survival of those patients improved from 22.8 months in the 1998 launched CONKO-001 study to 26.5 months in the 2008 launched CONKO-005 study and 34.8 months in the 2012 launched PRODIGY 24/CCTG PA.6 study. The difference in median overall survival and median recurrence-free survival increased from 9.4 to 22.0 months during the 15-year period of time. Actually, several factors have been considered affect the median RFS and/or OS of patients with pancreatic cancer after the R0/R1 resection, such as the emergence of more effective primary chemotherapy for patients with recurrent or metastatic diseases, FOLFIRINOX and nab-paclitaxel plus gemcitabine, after 2010 and 2013, the applications of regular surveillance for early recurrence detection, the inclusion of patients with high CA 19.9 level and/or the proportion of patients with R0/R1 resection as well as the use of different definition of R0 resection, and dose intensity of adjuvant chemotherapy, etc. All of which will be discussed in the meeting.
