# PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer

Source: https://onco.cc/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/  
OnCo record `paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Six months of the four-drug combination modified FOLFIRINOX after surgery for pancreatic cancer kept the disease away for almost twice as long as gemcitabine alone and added about a year and a half to median survival. It is the reason fit patients are now offered FOLFIRINOX after a pancreatic operation.

## Summary

Randomised phase 3 trial in 493 patients in France and Canada who had undergone a complete (R0 or R1) resection of pancreatic ductal adenocarcinoma, had a CA19-9 below 180 U/mL and were fit enough for combination chemotherapy. Patients received six months of modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin and infusional fluorouracil without the bolus) or gemcitabine.

At a median follow-up of 33.6 months, median disease-free survival was 21.6 months with modified FOLFIRINOX against 12.8 months with gemcitabine (hazard ratio 0.58), and median overall survival 54.4 against 35.0 months (hazard ratio 0.64). Grade 3 or 4 adverse events were more frequent with modified FOLFIRINOX (about 76 against 53 percent). Five-year results published in 2022 confirmed the survival benefit.

## Fields

- Kind: Key paper
- Last checked: 2026-09-21
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1809775
- Authors: Conroy T, Hammel P, Hebbar M, et al.
- Findings: Median disease-free survival 21.6 versus 12.8 months, hazard ratio 0.58.; Median overall survival 54.4 versus 35.0 months, hazard ratio 0.64.; Grade 3 or 4 adverse events in about 76 percent with modified FOLFIRINOX and 53 percent with gemcitabine.
- What it means: 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.
- Caveats: Patients were selected for fitness and a low postoperative CA19-9, so the result does not transfer directly to frailer patients.; Adjuvant chemotherapy must start within 12 weeks of surgery, and many patients never recover enough to receive it, which is one argument for neoadjuvant treatment.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1809775
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30575490/

## Connected records

- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- drugs: [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- trials: [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/)
- people: [Thierry Conroy](https://onco.cc/people/thierry-conroy/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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