Over the past two decades, it has been increasingly recognized that patients who undergo pancreatectomy for pancreatic cancer do better when they are administered chemotherapy after their operation.
Prior to the 1990s, there was only one drug administered to patients with pancreatic cancer at all—5FU. In 1997, however, a study showed that patients with inoperable pancreatic cancer lived longer and had fewer symptoms when treated with a new drug called gemcitabine than when they were treated with 5FU. Based on the results of this study, gemcitabine quickly became standard treatment for patients with inoperable pancreatic cancer. But its value when given after surgery was unknown. So over 50% of patients who got an operation in the 80s and 90s never received any treatment after surgery—even at major surgical hospitals.
In 2007, a large study of over three hundred patients was performed in Germany and Austria. The study randomized patients who had undergone curative surgery to receive either nothing (“observation”) or gemcitabine. The duration of time that elapsed between surgery and cancer relapse of patients who received gemcitabine was significantly longer than that of those who did not. Although another large European study showed that gemcitabine was no better than 5-FU when given after surgery, gemcitabine became standard postoperative therapy worldwide largely based on the results of this trial.
Last year, another European study showed that patients with inoperable pancreatic cancer who received a combination of drugs—called FOLFIRINOX—lived even longer than patients who received gemcitabine. In fact, the survival of patients who received FOLFIRINOX was almost twice as long as that of patients who received gemcitabine! Given the failure of multiple other otherwise promising regimens when compared to gemcitabine, this was remarkable. This was a truly revolutionary study that generated an understandable amount of excitement among doctors and patients worldwide.