A Whipple procedure (pancreaticoduodenectomy) specimen from a 60-year-old man shows pancreatic ductal adenocarcinoma with perineural invasion and R0 resection margins. Post-operatively, what is the current standard adjuvant chemotherapy regimen according to ESPAC-4 and APACT trials?
- A Gemcitabine alone for 6 months
- B Gemcitabine plus capecitabine (GEMCAP) for 6 months ✓
- C FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin)
- D Adjuvant chemoradiation with 5-FU (GITSG protocol)
Correct answer: B. Gemcitabine plus capecitabine (GEMCAP) for 6 months
Explanation
The ESPAC-4 trial demonstrated that adjuvant gemcitabine plus capecitabine (GEMCAP) significantly improves overall survival compared to gemcitabine alone after resection of pancreatic ductal adenocarcinoma (28.0 vs 25.5 months median OS), making GEMCAP the standard adjuvant regimen in fit patients. Modified FOLFIRINOX is used in the neoadjuvant setting or for metastatic disease. The older GITSG protocol using chemoradiation is no longer standard. APACT investigated nab-paclitaxel plus gemcitabine but did not meet its primary DFS endpoint.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.