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Six months of the four-drug combination modified FOLFIRINOX after surgery for pancreatic cancer kept the disease away for almost twice as long as gemcitabine alone and added about a year and a half to median survival. It is the reason fit patients are now offered FOLFIRINOX after a pancreatic operation.
Randomised phase 3 trial in 493 patients in France and Canada who had undergone a complete (R0 or R1) resection of pancreatic ductal adenocarcinoma, had a CA19-9 below 180 U/mL and were fit enough for combination chemotherapy. Patients received six months of modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin and infusional fluorouracil without the bolus) or gemcitabine.
At a median follow-up of 33.6 months, median disease-free survival was 21.6 months with modified FOLFIRINOX against 12.8 months with gemcitabine (hazard ratio 0.58), and median overall survival 54.4 against 35.0 months (hazard ratio 0.64). Grade 3 or 4 adverse events were more frequent with modified FOLFIRINOX (about 76 against 53 percent). Five-year results published in 2022 confirmed the survival benefit.
Modified FOLFIRINOX is the adjuvant standard for patients who recover well from a pancreatic resection and can tolerate combination chemotherapy; gemcitabine-based regimens remain for those who cannot.
The best survival ever recorded in a pancreatic cancer trial, and the benchmark every perioperative trial (PREOPANC-3, Alliance A021806) and every adjuvant RAS inhibitor or vaccine trial (RASolute 304, IMCODE003) now has to beat or add to.
The formal adoption of PRODIGE 24 into practice; every later debate about giving chemotherapy before rather than after surgery starts from this recommendation.
Shares Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial, PRODIGE 24 / CCTG PA6, 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.
Shares FOLFIRINOX / mFOLFIRINOX, 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 Thierry Conroy, PRODIGE 24 / CCTG PA6, 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 FOLFIRINOX / mFOLFIRINOX, 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 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 PRODIGE 24 / CCTG PA6, Resectable pancreatic ductal adenocarcinoma, 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 Thierry Conroy, PRODIGE 24 / CCTG PA6, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Gemcitabine.