Never enough.

Virtually no treatment algorithm for any pancreatic cancer is without chemotherapy, but when can we call it a day? Adjuvant treatment, particularly FOLFIRINOX, after upfront resection of pancreatic cancer has been a mainstay of treatment since the landmark PRODIGE 24 trial. Many current protocols, however, have moved chemo to the neoadjuvant setting recognizing it as the priority treatment. This retrospective series of 430 consecutive patients with ypN0 resections of pancreatic cancer following neoadjuvant chemo at UPMC and the Medical College of Wisconsin reports further adjuvant chemo improved median progression-free survival from 2.1 → 4.1 months and overall survival from 3.5 → 5.3 years, with even bigger improvements seen among those with perineural invasion. | Hammas, JAMA Surg 2022