# Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial

Source: https://onco.cc/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/  
OnCo record `paper-prodige-24-five-year-outcomes-jama-oncol-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2022 five-year report of PRODIGE 24 confirming that modified FOLFIRINOX after pancreatic cancer surgery gives a median survival of about four and a half years against three with gemcitabine, and that 43 percent of patients were alive at five years.

## Summary

The mature analysis of the PRODIGE 24/Canadian Cancer Trials Group PA6 trial, 493 patients aged 18 to 79 randomised at 77 hospitals in France and Canada between April 2012 and October 2016 within 3 to 12 weeks of R0 or R1 resection to 24 weeks of modified FOLFIRINOX or gemcitabine; data cutoff June 2021, median follow-up 69.7 months. Median disease-free survival was 21.4 versus 12.8 months (hazard ratio 0.66) and five-year disease-free survival 26.1 versus 19.0 percent; median overall survival was 53.5 versus 35.5 months (hazard ratio 0.68, 95 percent confidence interval 0.54 to 0.85, P = 0.001) and five-year overall survival 43.2 versus 31.4 percent; median metastasis-free survival 29.4 versus 17.7 months (hazard ratio 0.64) and cancer-specific survival 54.7 versus 36.3 months (hazard ratio 0.65). Multivariable analysis identified modified FOLFIRINOX, age, tumour grade, staging and larger-volume centre as favourable prognostic factors.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: JAMA Oncology
- Year: 2022
- DOI: 10.1001/jamaoncol.2022.3829
- Authors: Conroy T, Castan F, Lopez A, et al.
- Findings: 493 patients; median follow-up 69.7 months.; Median overall survival 53.5 versus 35.5 months (hazard ratio 0.68); five-year overall survival 43.2 versus 31.4 percent.; Median disease-free survival 21.4 versus 12.8 months (hazard ratio 0.66); metastasis-free survival 29.4 versus 17.7 months.; Larger-volume centre was an independent favourable prognostic factor.
- What it means: 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.
- Caveats: Fit patients under 80 who had recovered from surgery within 12 weeks; a minority of all diagnosed patients.; The centre-volume finding is observational within the trial but supports centralisation of pancreatic surgery.

## Sources

- JAMA Oncol 2022: https://doi.org/10.1001/jamaoncol.2022.3829
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36048453/
- ClinicalTrials.gov NCT01526135: https://clinicaltrials.gov/study/NCT01526135

## Connected records

- key papers: [Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial](https://onco.cc/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/), [Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update](https://onco.cc/key-papers/paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019/), [PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer](https://onco.cc/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- drugs: [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- companies: [UNICANCER](https://onco.cc/companies/unicancer/)
- terms: [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Overall survival (OS)](https://onco.cc/terms/os/)
- trials: [A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC](https://onco.cc/trials/nct05968326/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [Study of Daraxonrasib (RMC-6236) in Patients With Resected Pancreatic Ductal Adenocarcinoma (PDAC)](https://onco.cc/trials/nct07252232/)
- people: [Thierry Conroy](https://onco.cc/people/thierry-conroy/)
- journals: [JAMA Oncology](https://onco.cc/journals/jama-oncology/)
- roadmaps: [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/)
- ideas: [Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed](https://onco.cc/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/)

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