About a third of all pancreatic cancer is found to be locally advanced at the time of diagnosis, where the tumor is inoperablebut remains localized to the pancreas and regional lymphatics. Sadly, this remains a universally deadly disease withprogression to distant disease being the predominant mode of failure and average survival under one year. Optimaltreatment of these patients continues to be an area of controversy, with chemotherapy alone being the treatment preferencein Europe, and chemotherapy followed by chemoradiation in selected patients, preferred in the USA. The aim of this paper isto summarize the key abstracts presented at the 2013 ASCO Annual Meeting that address evolving approaches to themanagement of locally advanced pancreatic cancer. The late breaking abstract (#LBA4003) provided additional Europeandata showing non-superiority of chemoradiation compared to chemotherapy in locally advanced pancreatic cancer patientswithout distant progression following 4 months of chemotherapy. Another late breaking abstract, (#LBA4004),unfortunately showed a promising new complement to gemcitabine and capecitabine using immunotherapy in the form of aT-helper vaccine did not translate to improved survival in the phase III setting.
Muhammad Wasif Saif, Kathryn E Huber, Guy Savir