Top Line: What is the best systemic therapy regimen for borderline resectable pancreatic ductal carcinoma?
The Study: Currently, the preferred approach of borderline resectable PDAC is neoadjuvant FOLFIRINOX, although PREOPANC-2 showed similar outcomes with neoadjuvant chemoradiation. PACT-21 CASSANDRA was a phase 3 trial that randomized 260 patients with borderline resectable PDAC were randomized in a 2×2 fashion to receive 4 months of neoadjuvant mFOLFIRINOX or PAXG (cisplatin, nab-paclitaxel, capecitabine, and gemcitabine) and then to receive an additional 2 months of chemotherapy either before or after surgery. The goal here was to try and take advantage of the potential taxane/platinum and taxane/fluoropyrimidine synergism to improve treatment outcomes. Median EFS was significantly improved with PAXG compared to mFOLFIRINOX (16 v 10.2 months). The overall rate of grade 3+ toxicity was similar between groups (66% v 61%).
TBL: In the CASSANDRA trial, the neoadjuvant PAXG regimen improved EFS over mFOLFIRINOX for borderline resectable pancreatic cancer. | Reni, Lancet 2025
The Study: Currently, the preferred approach of borderline resectable PDAC is neoadjuvant FOLFIRINOX, although PREOPANC-2 showed similar outcomes with neoadjuvant chemoradiation. PACT-21 CASSANDRA was a phase 3 trial that randomized 260 patients with borderline resectable PDAC were randomized in a 2×2 fashion to receive 4 months of neoadjuvant mFOLFIRINOX or PAXG (cisplatin, nab-paclitaxel, capecitabine, and gemcitabine) and then to receive an additional 2 months of chemotherapy either before or after surgery. The goal here was to try and take advantage of the potential taxane/platinum and taxane/fluoropyrimidine synergism to improve treatment outcomes. Median EFS was significantly improved with PAXG compared to mFOLFIRINOX (16 v 10.2 months). The overall rate of grade 3+ toxicity was similar between groups (66% v 61%).
TBL: In the CASSANDRA trial, the neoadjuvant PAXG regimen improved EFS over mFOLFIRINOX for borderline resectable pancreatic cancer. | Reni, Lancet 2025