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This combination treatment regimen refers to the therapeutic strategy evaluated in the National Cancer Institute (NCI) sponsored Phase II/III trial (RTOG 0848) for the adjuvant treatment of resected pancreatic adenocarcinoma. The regimen involves a sequence of adjuvant chemotherapy followed by potential chemoradiation. The chemotherapy component primarily utilizes gemcitabine hydrochloride, a nucleoside analog that inhibits DNA synthesis and ribonucleotide reductase, either alone or in combination with erlotinib hydrochloride, a small molecule tyrosine kinase inhibitor targeting the epidermal growth factor receptor (EGFR). Following the initial chemotherapy phase, patients may receive chemoradiation using either fluorouracil (5-FU) or its oral prodrug capecitabine as radiosensitizing agents. These antimetabolites inhibit thymidylate synthase, thereby interfering with pyrimidine metabolism and DNA repair, which enhances the cytotoxic effects of radiation therapy in the tumor microenvironment.
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