DR FUCHS: I think that, to some extent, the standard becomes the CONKO study, namely using single-agent gemcitabine after resection. Existing questions are on the role of radiation therapy where, for the most part, on the other side of the Atlantic there isn’t much use.
There’s not much enthusiasm for radiation. There’s still some on this side, partly because most of our studies in the US, in North America, have included radiation therapy. But at our center, often if we were to use gemcitabine and were contemplating radiation because we don’t routinely use it, usually we’ll give 4 cycles of gemcitabine, restage them and make sure that they haven’t progressed before contemplating radiation just because you’d want to delay that as long as possible just to be certain they don’t develop any early systemic recurrence. FOLFIRINOX is certainly a question.
There is yet no data about using FOLFIRINOX in this setting. So I have not routinely used FOLFIRNOX as an adjuvant therapy.
DR KULKE: Yes, I would agree. I think FOLFIRNOX always comes up simply because of the data in the metastatic setting. So you have to discuss it. But it’s no picnic to give or to receive. And so before moving it to the adjuvant setting, I’d really want to see a little bit more data.
DR GOLDBERG: I agree with everything that’s been said. FOLFIRNOX is hard to take, and you commonly end up doing dose reductions. All these people that are post-Whipple are fairly beaten up and so, even though giving it in people with advanced disease is difficult, it would be more difficult in the postoperative setting.