Top Line: PREOPANC-1 demonstrated broad advantages in disease and survival outcomes with with neoadjuvant chemoradiation compared to adjuvant gemcitabine-based chemotherapy for resectable or borderline resectable pancreatic cancer.
The Study: The predictable problem was, by the time results matured, gem-based chemo was replaced by FOLFIRINOX as the preferred systemic therapy in this setting. PREOPANC-2 was designed to assess if neoadjuvant FOLFIRINOX can incrementally move the needle even farther than what is achieved with neoadjuvant chemoradiation. This Dutch phase 3 trial randomized 369 evaluable patients with resectable or borderline resectable pancreatic cancer to FOLFIRINOX q2 weeks x 8 cycles followed by surgery versus gemcitabine q3 weeks x 3 cycles with radiation to 36 Gy in 15 fractions during the second cycle followed by surgery then adjuvant gemcitabine x 4 cycles. The initial abstract presented at ESMO 2023 reports no difference in median overall survival (22 months with FOLFIRINOX versus 21 months with chemoradiation), resection rates (77% versus 75%), or severe toxicity (49% versus 43%).
TBL:In PREOPANC-2, neoadjuvant FOLFIRINOX did not significantly improve survival or resectability compared to gemcitabine-based chemotherapy and low-dose radiation for potentially resectable pancreatic cancer. | Koerkamp, ESMO 2023
The Study: The predictable problem was, by the time results matured, gem-based chemo was replaced by FOLFIRINOX as the preferred systemic therapy in this setting. PREOPANC-2 was designed to assess if neoadjuvant FOLFIRINOX can incrementally move the needle even farther than what is achieved with neoadjuvant chemoradiation. This Dutch phase 3 trial randomized 369 evaluable patients with resectable or borderline resectable pancreatic cancer to FOLFIRINOX q2 weeks x 8 cycles followed by surgery versus gemcitabine q3 weeks x 3 cycles with radiation to 36 Gy in 15 fractions during the second cycle followed by surgery then adjuvant gemcitabine x 4 cycles. The initial abstract presented at ESMO 2023 reports no difference in median overall survival (22 months with FOLFIRINOX versus 21 months with chemoradiation), resection rates (77% versus 75%), or severe toxicity (49% versus 43%).
TBL:In PREOPANC-2, neoadjuvant FOLFIRINOX did not significantly improve survival or resectability compared to gemcitabine-based chemotherapy and low-dose radiation for potentially resectable pancreatic cancer. | Koerkamp, ESMO 2023