Adjuvant therapy for pancreas cancer in an era of value based cancer care

• Type of Material: Article
• Authors: Daniel H. Ahn, Ohio State University; Terence M. Williams, Ohio State University; Daniel Goldstein, Emory University; Bassel El-Rayes, Emory University; Tanios Bekaii-Saab, Ohio State University
• Language: English
• Date: 2016-01-01
• Publisher: Elsevier Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2015 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ctrv.2015.11.004
• Title of Journal or Parent Work: Cancer Treatment Reviews
• ISSN: 0305-7372
• Volume: 42
• Start Page: 10
• End Page: 17
• Keywords: Life Sciences & Biomedicine; DUCTAL ADENOCARCINOMA; Oncology; Net health benefit; PLUS GEMCITABINE; Chemotherapy; Pancreatic cancer; CURATIVE RESECTION; RADIATION-THERAPY; Chemoradiation; METASTATIC COLORECTAL-CANCER; Adjuvant therapy; PROTON-BEAM THERAPY; PHASE-III TRIAL; SHORT-COURSE CHEMORADIATION; Science & Technology; RANDOMIZED CONTROLLED-TRIAL; STEREOTACTIC BODY RADIOTHERAPY
• Research Categories: Health Sciences, Oncology; Health Sciences, Health Care Management

Abstract

In resected pancreas cancer, adjuvant therapy improves outcomes and is considered the standard of care for patients who recover sufficiently post operatively. Chemotherapy or combined chemotherapy and radiation therapy (chemoradiation; CRT) are strategies used in the adjuvant setting. However, there is a lack of evidence to suggest whether the addition of RT to chemotherapy translates to an improvement in clinical outcomes. This is true even when accounting for the subset of patients with a higher risk for recurrence, such as those with R1 and lymph node positive disease. When considering the direct and indirect costs, impact on quality of life and questionable added clinical benefit, the true "net health benefit" from added RT to chemotherapy becomes more uncertain. Future directions, including the utilization of modern RT, integration of novel therapies, and intensifying chemotherapy regimens may improve outcomes in resected pancreas cancer.