Radiochemoimmunotherapy for pancreatic cancer

After they undergo surgical intervention with curative intention in specialized centers, the 5-year survival rate of patients with carcinoma of the exocrine pancreas is only 15%. The European Study Group For Pancreatic Cancer (ESPAC) –1 trial showed that an increased 5-year survival rate of 21% was achieved with adjuvant chemotherapy. Investigators from the Virginia Mason Clinic have reported a 5-year survival rate of 55% in a phase II trial evaluating adjuvant chemotherapy, immunotherapy, and external-beam radiation. This article discusses the potential role of radiochemoimmunotherapy for adjuvant treatment; describes the ongoing phase III randomized controlled trial, Adjuvant ChemoRadioImmunotherapy of Pancreatic Carcinoma (CapRI); and compares the regimen from the Virginia Mason Clinic with the best arm of ESPAC-1. First data regarding the toxicity are shown. This article illustrates possible modes of action of radiochemoimmunotherapy and shows how translational research might help to shed some light on the underlying mechanisms as well as define predictive markers.