{"entity":{"id":"paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019","kind":"paper","name":"Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"J Clin Oncol 2019","url":"https://doi.org/10.1200/JCO.19.00946"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/31180816/"}],"tags":["pancreatic-evidence"],"related":["paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018"],"cancers":["pancreatic","resectable-pdac"],"sections":[],"technologies":[],"targets":[],"drugs":["folfirinox","gemcitabine","capecitabine"],"companies":[],"institutions":["asco"],"pathways":[],"terms":["neoadjuvant-adjuvant"],"trials":["prodige-24"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2019,"doi":"10.1200/JCO.19.00946","pmid":"31180816","authors":"Khorana AA, McKernin SE, Berlin J, et al.","paperType":"guideline","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."],"whatItMeans":"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."],"changedPractice":true},"route":"/key-papers/paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019/","neighbours":{"paper":[{"id":"paper-prodige-24-five-year-outcomes-jama-oncol-2022","kind":"paper","name":"Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial","route":"/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/"},{"id":"paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018","kind":"paper","name":"PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer","route":"/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/"}],"cancer":[{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"drug":[{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"folfirinox","kind":"drug","name":"FOLFIRINOX / mFOLFIRINOX","route":"/drugs/folfirinox/"},{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"}],"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"trial":[{"id":"prodige-24","kind":"trial","name":"PRODIGE 24 / CCTG PA6","route":"/trials/prodige-24/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}]}}