# Event-free / disease-free survival (EFS, DFS, iDFS, RFS)

Source: https://onco.cc/terms/efs/  
OnCo record `efs` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In early-stage cancer: how long patients stay free of recurrence, progression, or death.

## Summary

Event-free survival and its relatives, disease-free survival, invasive disease-free survival and recurrence-free survival, are the endpoints used in early-stage cancer to measure how long patients stay free of recurrence, progression or death. Event definitions differ by trial: EFS in KEYNOTE-522 counts progression that precludes surgery, iDFS in monarchE and NATALEE counts invasive recurrence, second cancers and death, and RFS is the measure in INTerpath-001 (V940-001). These endpoints are accepted surrogates for adjuvant approvals. They appear in the NADINA, KEYNOTE-716, KEYNOTE-689, MATTERHORN, ZUMA-7, ASCENT-05 / OptimICE-RD and TROPION-Breast03 trial records, in the Neuroblastoma (paediatric) entry and in the KEYNOTE-522 and CheckMate 816 papers.

## Fields

- Kind: Term
- Last checked: 2026-09-04
- Also known as: EFS; DFS; iDFS; RFS; event-free survival; recurrence-free survival; recurrence-free; relapse-free survival; relapse-free; invasive disease-free survival; distant disease-free survival; distant recurrence-free; failure-free survival; time to recurrence

## Notes

- Disease-free survival is the primary endpoint of the adjuvant pancreatic cancer trials: in PRODIGE 24 median disease-free survival was 21.6 months with modified FOLFIRINOX against 12.8 months with gemcitabine (hazard ratio 0.58 for a cancer-related event, second cancer or death), and overall survival followed (Conroy 2018). The definition, time from randomisation to any event irrespective of cause, follows the adjuvant-trial consensus (Punt 2007).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Disease-free_survival
- Wikipedia: https://en.wikipedia.org/wiki/Disease-free_survival
- Conroy, N Engl J Med 2018: PRODIGE 24, modified FOLFIRINOX or gemcitabine as adjuvant therapy (disease-free survival primary endpoint): https://doi.org/10.1056/nejmoa1809775
- Punt, JNCI 2007: endpoints in adjuvant treatment trials, systematic review and proposed definitions (disease-free survival): https://doi.org/10.1093/jnci/djm024

## Connected records

- terms: [Absolute versus relative benefit (number needed to treat)](https://onco.cc/terms/absolute-benefit/), [Clinical benefit response (the gemcitabine trial endpoint)](https://onco.cc/terms/clinical-benefit-response/), [Endpoint](https://onco.cc/terms/endpoint/), [Group sequential design, stopping rules and alpha spending](https://onco.cc/terms/group-sequential-design/), [Invasive](https://onco.cc/terms/invasive-cancer/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Overall survival (OS)](https://onco.cc/terms/os/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Primary, secondary and co-primary endpoints](https://onco.cc/terms/primary-endpoint/), [Recurrence and relapse](https://onco.cc/terms/relapse-recurrence/), [Registry-based randomised trial](https://onco.cc/terms/registry-based-trial/), [Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point](https://onco.cc/terms/tnbc-residual-disease-decision/), [Surrogate endpoint](https://onco.cc/terms/surrogate-endpoint/), [Surrogate endpoint validation: which stand-ins have earned trust](https://onco.cc/terms/surrogate-validation/), [Time to progression (TTP) and time to next treatment (TTNT)](https://onco.cc/terms/ttp/)
- cancers: [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year)](https://onco.cc/cancers/all-infant/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Neuroblastoma (paediatric)](https://onco.cc/cancers/neuroblastoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/), [Stage III melanoma (after surgery)](https://onco.cc/cancers/stage-iii-melanoma/), [Standard-risk B-cell acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-standard-risk/)
- trials: [A-BRAVE](https://onco.cc/trials/a-brave/), [ADAURA](https://onco.cc/trials/adaura/), [ALEXANDRA / IMpassion030](https://onco.cc/trials/impassion030/), [ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63)](https://onco.cc/trials/ascent-05/), [BRE12-158 (Hoosier Oncology Group)](https://onco.cc/trials/bre12-158/), [BWEL (Breast Cancer Weight Loss, Alliance A011401)](https://onco.cc/trials/bwel/), [CALGB 40603 (Alliance)](https://onco.cc/trials/calgb-40603/), [CHALLENGE (CCTG CO.21)](https://onco.cc/trials/challenge/), [CheckMate 238](https://onco.cc/trials/checkmate-238/), [CREATE-X](https://onco.cc/trials/create-x/), [ECOG-ACRIN EA1131](https://onco.cc/trials/ea1131/), [GEICAM/2003-11_CIBOMA/2004-01](https://onco.cc/trials/geicam-ciboma/), [GeparDouze / NSABP B-59](https://onco.cc/trials/gepardouze/), [INTerpath-001 (V940-001)](https://onco.cc/trials/interpath-001/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/), [KEYNOTE-564](https://onco.cc/trials/keynote-564/), [KEYNOTE-689](https://onco.cc/trials/keynote-689/), [KEYNOTE-716](https://onco.cc/trials/keynote-716/), [MATTERHORN](https://onco.cc/trials/matterhorn/), [monarchE](https://onco.cc/trials/monarche/), [NADINA](https://onco.cc/trials/nadina/), [NATALEE](https://onco.cc/trials/natalee/), [NeoTRIP (NeoTRIPaPDL1)](https://onco.cc/trials/neotrip/), [NIVOPOSTOP (GORTEC 2018-01)](https://onco.cc/trials/nivopostop/), [SWOG S1418 / NRG BR006](https://onco.cc/trials/swog-s1418/), [SYSUCC-001](https://onco.cc/trials/sysucc-001/), [TROPION-Breast03](https://onco.cc/trials/tropion-breast03/), [ZUMA-7](https://onco.cc/trials/zuma-7/)
- key papers: [AGILE: ivosidenib plus azacitidine for newly diagnosed IDH1-mutated AML in patients unfit for intensive chemotherapy](https://onco.cc/key-papers/paper-agile-ivosidenib-azacitidine-nejm-2022/), [CheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgery](https://onco.cc/key-papers/paper-checkmate-816-nejm-2022/), [Children's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALL](https://onco.cc/key-papers/paper-aall1731-blinatumomab-children-nejm-2025/), [ELIANA: the global trial that made tisagenlecleucel the first approved CAR-T therapy for children and young adults with relapsed ALL](https://onco.cc/key-papers/paper-eliana-tisagenlecleucel-nejm-2018/), [KEYNOTE-522: adding pembrolizumab before and after surgery in early triple-negative breast cancer](https://onco.cc/key-papers/paper-keynote-522-nejm-2022/), [Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase III trial](https://onco.cc/key-papers/paper-geyer-brightness-4-year-follow-up-ann-oncol-2022/), [NADINA: two doses of ipilimumab plus nivolumab before surgery beat a year of nivolumab after surgery in stage III melanoma](https://onco.cc/key-papers/paper-nadina-nejm-2024/), [NIAGARA: durvalumab before and after cystectomy for muscle-invasive bladder cancer](https://onco.cc/key-papers/paper-niagara-nejm-2024/), [Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis](https://onco.cc/key-papers/paper-cortazar-ctneobc-pcr-pooled-analysis-lancet-2014/), [Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients](https://onco.cc/key-papers/paper-yau-rcb-pooled-analysis-5161-lancet-oncol-2022/), [TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma](https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- bottlenecks: [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)

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