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Giving chemotherapy and radiotherapy before the operation, rather than operating first, tripled the share of patients alive at five years in this Dutch trial, with the gain clearest in borderline resectable tumours. It is the strongest randomised case for treating borderline resectable pancreatic cancer before surgery.
Long-term analysis of the Dutch Pancreatic Cancer Group's randomised phase 3 PREOPANC trial, in which 246 patients with resectable or borderline resectable pancreatic cancer were assigned to neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine, or to immediate surgery followed by adjuvant gemcitabine.
With a median follow-up of 59 months, overall survival favoured the neoadjuvant arm (hazard ratio 0.73), with five-year survival of 20.5 percent against 6.5 percent even though median survival differed by little (15.7 against 14.3 months). The benefit was significant in the borderline resectable subgroup and consistent across the others. The 2020 primary report had shown better R0 resection rates and disease-free survival without a significant overall survival difference.
Neoadjuvant treatment is now the standard for borderline resectable pancreatic cancer, and PREOPANC is the trial guidelines cite; the follow-on PREOPANC-2 tested FOLFIRINOX in the same setting.
Shares Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial, PREOPANC-1, Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Borderline resectable pancreatic ductal adenocarcinoma.
Shares PREOPANC-1, Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma.
Shares Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma.
Shares Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial, PREOPANC-1, Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Borderline resectable pancreatic ductal adenocarcinoma.
Shares Borderline resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Gemcitabine, Pancreatic ductal adenocarcinoma.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Gemcitabine, Pancreatic ductal adenocarcinoma.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Gemcitabine, Pancreatic ductal adenocarcinoma.
Shares Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma, Gemcitabine.