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ESPAC-5 randomised people whose pancreatic cancer sat on the border of being removable between going straight to surgery and having two months of chemotherapy or chemoradiotherapy first; those treated first were far more likely to be alive a year later, 78 to 84 percent with chemotherapy against 39 percent with immediate surgery, which supports treating before operating in borderline disease.
ESPAC-5 was a four-arm randomised phase 2 feasibility trial of the European Study Group for Pancreatic Cancer at 16 sites, randomising 90 patients with borderline resectable pancreatic cancer to immediate surgery (33), or two months of neoadjuvant gemcitabine plus capecitabine (20), FOLFIRINOX (20) or capecitabine-based chemoradiotherapy (17), each followed by surgery and adjuvant chemotherapy. The primary endpoints were recruitment rate and resection rate.
Resection rates were similar (68 percent after immediate surgery, 55 percent after neoadjuvant therapy) and R0 rates low in both (14 and 23 percent), but one-year overall survival was 39 percent with immediate surgery against 78 percent with gemcitabine plus capecitabine, 84 percent with FOLFIRINOX and 60 percent with chemoradiotherapy, and one-year disease-free survival from surgery was 33 against 59 percent (hazard ratio 0.53). The corpus's borderline resectable pancreatic cancer page cites ESPAC-5 with PREOPANC for neoadjuvant treatment and restaging before surgery.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
90 randomised.
21 of 31 · 30 of 55
Source95% CI 24 to 61 · 95% CI 60 to 100 · 95% CI 70 to 100 · 95% CI 37 to 97
Source95% CI 19 to 58 · 95% CI 46 to 74
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Resection rateprimary | Immediate surgery | 31 | 68% | - | 0.33 | link |
| Neoadjuvant therapy arms combined | 55 | 55% | ||||
| Overall survival at 1 year | Immediate surgery | 31 | 39% | - | 0.0028 | link |
| Neoadjuvant gemcitabine + capecitabine | 19 | 78% | ||||
| Neoadjuvant FOLFIRINOX | 20 | 84% | ||||
| Neoadjuvant capecitabine-based chemoradiotherapy | 16 | 60% | ||||
| Disease-free survival at 1 year from surgery | Immediate surgery | - | 33% | 0.53 (0.28 to 0.98) | 0.016 | link |
| Neoadjuvant therapy arms combined | - | 59% | ||||
| R0 resection among resected patients | Immediate surgery | 21 | 14% | - | 0.49 | link |
| Neoadjuvant therapy arms combined | 30 | 23% |
Shares Daniel Palmer, Paula Ghaneh, Liverpool University Hospitals HPB centre (Aintree), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question and the tag soc-trials.
Shares Paula Ghaneh, Liverpool University Hospitals HPB centre (Aintree), Gemcitabine, Pancreatic ductal adenocarcinoma and the tag soc-trials.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Capecitabine, Gemcitabine, IMRT / IGRT (modern external beam) and the tag soc-trials.
Shares 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, Cytotoxic chemotherapy and the tag soc-trials.
Shares Gemcitabine, IMRT / IGRT (modern external beam), Cytotoxic chemotherapy and the tag soc-trials.
Shares Gemcitabine, IMRT / IGRT (modern external beam), Cytotoxic chemotherapy and the tag soc-trials.
Shares FOLFIRINOX / mFOLFIRINOX, Pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy and the tag soc-trials.
Shares Capecitabine, Cytotoxic chemotherapy and the tag soc-trials.