# ESPAC-5

Source: https://onco.cc/trials/espac-5/  
OnCo record `espac-5` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-22
- Also known as: ESPAC5; ESPAC-5F
- Tags: soc-trials
- Phase: 2
- Setting: Borderline resectable pancreatic cancer in the United Kingdom and Germany: immediate surgery against short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX or capecitabine-based chemoradiotherapy, each followed by surgery and adjuvant chemotherapy, with recruitment and resection rate as the primary endpoints of a four-arm feasibility trial
- Sponsor: University of Liverpool (Cancer Research UK)
- Enrolled: 90
- Result: One-year overall survival 39 percent with immediate surgery against 78 percent with neoadjuvant gemcitabine plus capecitabine, 84 percent with FOLFIRINOX and 60 percent with chemoradiotherapy (p 0.0028); resection rates similar (68 against 55 percent).
- Outcomes: Resection rate: Immediate surgery 68% vs Neoadjuvant therapy arms combined 55%; Overall survival at 1 year: Immediate surgery 39% vs Neoadjuvant gemcitabine + capecitabine 78% vs Neoadjuvant FOLFIRINOX 84% vs Neoadjuvant capecitabine-based chemoradiotherapy 60%; Disease-free survival at 1 year from surgery: Immediate surgery 33% vs Neoadjuvant therapy arms combined 59%, HR 0.53; R0 resection among resected patients: Immediate surgery 14% vs Neoadjuvant therapy arms combined 23%

## Sources

- Lancet Gastroenterol Hepatol 2023: https://doi.org/10.1016/S2468-1253(22)00348-X

## Connected records

- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- key papers: [ESPAC-5: immediate surgery versus short-course neoadjuvant chemotherapy or chemoradiotherapy in borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-espac-5-neoadjuvant-borderline-resectable-ghaneh-lancet-gastroenterol-hepatol-2023/)

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