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Showed that giving the strong four-drug chemotherapy after pancreatic surgery adds years of life for fit patients.
PRODIGE 24, run with the Canadian Cancer Trials Group as CCTG PA6, trial NCT01526135 and reported in 2018, showed that giving modified FOLFIRINOX after pancreatic cancer surgery adds years of life for fit patients compared with gemcitabine. It randomised 493 patients and met its primary disease-free survival endpoint, and the overall survival benefit held in a five-year update in 2022, establishing modified FOLFIRINOX as the adjuvant standard for patients fit enough to receive it. OnCo links it to pancreatic ductal adenocarcinoma, to the FOLFIRINOX drug record and to Thierry Conroy, and the result is consistent with APACT for gemcitabine and nab-paclitaxel, which showed a smaller effect, and with the neoadjuvant PREOPANC-2 comparison. Whether the same regimen should be given before surgery rather than after is the open question. FOLFIRINOX has its own page.
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.
493 enrolled.
Step lines join published landmark estimates; the true curve between them is not shown.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Disease-free survivalprimary | Adjuvant mFOLFIRINOX | 247 | 21.6 months | 0.58 (0.46 to 0.73) | <0.001 | link |
| Adjuvant gemcitabine | 246 | 12.8 months | ||||
| Overall survival (5-year update) | Adjuvant mFOLFIRINOX | - | 53.5 months | 0.68 | - | link |
| Adjuvant gemcitabine | - | 35.5 months |
This is the European standard the UK and NHS page for pancreatic cancer is compared against; NICE guideline NG85 (2018) covers the same ground with an older evidence base and a narrower set of funded drugs.
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.
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.
FOLFIRINOX and, soon after, gemcitabine plus nab-paclitaxel ended the era of single-agent gemcitabine for metastatic pancreatic cancer. The regimen's modified form later improved survival after surgery in PRODIGE 24, and its toxicity is why fitness, not just stage, decides which treatment a patient is offered.
Shares PREOPANC-3, Alliance A021806, Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed.
Shares PREOPANC-3, Alliance A021806, Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, FOLFIRINOX / mFOLFIRINOX.
Shares Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, FOLFIRINOX / mFOLFIRINOX, Borderline resectable pancreatic ductal adenocarcinoma.
Shares Thierry Conroy, UNICANCER, FOLFIRINOX / mFOLFIRINOX, Topoisomerase-I inhibitors (and ADC payloads).
Shares Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up, FOLFIRINOX / mFOLFIRINOX, Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question.
Shares Alliance A021806, Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors.
Shares Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, FOLFIRINOX / mFOLFIRINOX, Borderline resectable pancreatic ductal adenocarcinoma.
Shares FOLFIRINOX / mFOLFIRINOX, Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma, Topoisomerase-I inhibitors (and ADC payloads).