# Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update

Source: https://onco.cc/key-papers/paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019/  
OnCo record `paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2019 American guideline update that made six months of modified FOLFIRINOX the preferred chemotherapy after pancreatic cancer surgery for patients fit enough to take it, on the strength of a single trial.

## Summary

ASCO convened an Expert Panel to evaluate PRODIGE 24/CCTG PA.6, the phase 3 trial of postoperative modified FOLFIRINOX versus gemcitabine presented at the 2018 ASCO Annual Meeting, and searched PubMed for other papers bearing on the existing recommendations. Only Recommendation 4.1 was updated: all patients with resected pancreatic adenocarcinoma who did not receive preoperative therapy should be offered six months of adjuvant chemotherapy in the absence of medical or surgical contraindications; modified FOLFIRINOX (oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 day 1, fluorouracil 2.4 g/m2 over 46 hours every 14 days for 12 cycles) is preferred in the absence of concerns for toxicity or tolerance; gemcitabine plus capecitabine, gemcitabine alone or fluorouracil plus folinic acid alone can be offered instead.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Journal of Clinical Oncology
- Year: 2019
- DOI: 10.1200/JCO.19.00946
- Authors: Khorana AA, McKernin SE, Berlin J, et al.
- Findings: Six months of adjuvant chemotherapy for every resected patient who had no preoperative therapy, absent contraindications.; Modified FOLFIRINOX for 12 cycles is preferred; gemcitabine plus capecitabine, gemcitabine or fluorouracil plus folinic acid are alternatives.
- What it means: The formal adoption of PRODIGE 24 into practice; every later debate about giving chemotherapy before rather than after surgery starts from this recommendation.
- Caveats: Based on one trial in fit patients aged 18 to 79; the guideline leaves the choice for less fit patients to the alternatives.; Written before PREOPANC-2, NORPACT-1 and Alliance A021806 addressed preoperative treatment of resectable disease.

## Sources

- J Clin Oncol 2019: https://doi.org/10.1200/JCO.19.00946
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31180816/

## Connected records

- key papers: [Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/), [PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer](https://onco.cc/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/)
- trials: [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)

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