Treatment for locally advanced pancreatic cancer. Chemotherapy vs chemoradiotherapy

Gemcitabine monotherapy has been widely used as the standard chemotherapy for unresectable pancreatic cancer including locally advanced disease, and S-1 monotherapy is accepted as an alternative treatment option in Japan. Chemoradiotherapy is also regarded as one of the treatment options for locally advanced pancreatic cancer, but has not demonstrated any survival advantage over chemotherapy so far. Recently, 'induction chemotherapy followed by chemoradiotherapy' is increasingly utilized as a promising strategy in the West, and this approach is now being developed. On the other hand, combination chemotherapy, such as FOLFIRINOX and gemcitabine plus nab-paclitaxel, was demonstrated to be more effective than gemcitabine monotherapy in the metastatic setting. These regimens are also expected to improve survival in patients with locally advanced pancreatic cancer. (author)