# Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study

Source: https://onco.cc/key-papers/paper-panova-3-ttfields-locally-advanced-pancreatic-jco-2025/  
OnCo record `paper-panova-3-ttfields-locally-advanced-pancreatic-jco-2025` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2025 trial in which a wearable device delivering alternating electric fields to the abdomen, added to chemotherapy, lengthened survival in locally advanced pancreatic cancer from about 14 to 16 months and delayed the onset of pain.

## Summary

PANOVA-3 randomised 571 patients with newly diagnosed unresectable locally advanced pancreatic adenocarcinoma to gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2 on days 1, 8 and 15 of 28-day cycles with or without tumour treating fields. Overall survival, the primary endpoint, was 16.2 months (95 percent confidence interval 15.0 to 18.0) with the device against 14.2 months (12.8 to 15.4) without (hazard ratio 0.82, 0.68 to 0.99, P = 0.039). Progression-free survival, local progression-free survival and response rate were not improved. Pain-free survival was 15.2 versus 9.1 months (hazard ratio 0.74, P = 0.027) and distant progression-free survival, analysed post hoc, 13.9 versus 11.5 months (hazard ratio 0.74). Device-related skin adverse events occurred in 76.3 percent of patients, mostly mild to moderate, grade 3 in 7.7 percent, with no additive systemic toxicity.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Journal of Clinical Oncology
- Year: 2025
- DOI: 10.1200/JCO-25-00746
- Authors: Babiker HM, Picozzi V, Chandana SR, et al.
- Findings: 571 patients with unresectable locally advanced disease.; Overall survival 16.2 versus 14.2 months (hazard ratio 0.82, P = 0.039).; Progression-free survival, local control and response rate not improved; pain-free survival 15.2 versus 9.1 months.; Device-related skin events in 76.3 percent, grade 3 in 7.7 percent.
- What it means: The evidence behind the 2026 approval of Optune Pax for locally advanced disease, the first new approval in that setting in decades, and an unusual case of a survival gain without a progression-free survival gain.
- Caveats: Open-label with no sham device; the survival gain is two months and progression endpoints did not move.; Wearing the device for most of the day is a burden not captured by adverse event counts.

## Sources

- J Clin Oncol 2025: https://doi.org/10.1200/JCO-25-00746
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40448572/
- ClinicalTrials.gov NCT03377491: https://clinicaltrials.gov/study/NCT03377491

## Connected records

- roadmaps: [Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants](https://onco.cc/roadmaps/devices-roadmap/), [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- key papers: [LAP07: chemoradiotherapy versus chemotherapy after four months of gemcitabine in locally advanced pancreatic cancer](https://onco.cc/key-papers/paper-lap07-chemoradiotherapy-locally-advanced-pancreatic-hammel-jama-2016/), [Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study](https://onco.cc/key-papers/paper-babiker-j-clin-oncol/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/)
- technologies: [Tumour treating fields (TTFields)](https://onco.cc/technologies/ttfields/)
- drugs: [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/)
- companies: [Novocure](https://onco.cc/companies/novocure/)
- terms: [Overall survival (OS)](https://onco.cc/terms/os/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/)
- trials: [PANOVA-3](https://onco.cc/trials/panova-3/)
- people: [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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