A 65-year-old man undergoes Whipple's procedure (pancreaticoduodenectomy) for a 2.5 cm pancreatic head adenocarcinoma. Pathology shows R0 resection, N1 (3 of 18 nodes positive). Which adjuvant chemotherapy regimen is now the standard of care based on PRODIGE-24/APACT trials?

• A Modified FOLFIRINOX (mFOLFIRINOX) for 6 months ✓
• B Gemcitabine monotherapy for 6 months
• C Gemcitabine plus nab-paclitaxel for 6 months
• D Capecitabine monotherapy for 6 months

Explanation

The PRODIGE-24 trial demonstrated that mFOLFIRINOX (oxaliplatin, irinotecan, leucovorin, 5-FU at modified doses) as adjuvant therapy after R0/R1 resection for pancreatic ductal adenocarcinoma significantly improved median overall survival (54.4 vs 35.0 months) compared to gemcitabine alone. mFOLFIRINOX is now the preferred adjuvant regimen for fit patients (ECOG PS 0-1). Gemcitabine-nab-paclitaxel showed benefit in the APACT trial but did not achieve improved DFS in the primary analysis, and mFOLFIRINOX remains preferred.

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.