# PREOPANC-2

Source: https://onco.cc/trials/preopanc-2/  
OnCo record `preopanc-2` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

PREOPANC-2 asked whether the strongest chemotherapy given entirely before surgery beats the Dutch standard of gemcitabine chemoradiotherapy before and gemcitabine after; survival was the same, about 22 months in both arms, so both remain reasonable ways to treat first, and the question of surgery first against treatment first moves to Alliance A021806 and PREOPANC-3.

## Summary

PREOPANC-2 randomised 375 patients with resectable or borderline resectable pancreatic ductal adenocarcinoma and WHO performance status 0 or 1 to total neoadjuvant FOLFIRINOX (eight two-weekly cycles, surgery, no adjuvant treatment) or the PREOPANC-1 regimen of neoadjuvant gemcitabine-based chemoradiotherapy, surgery and adjuvant gemcitabine. After a median follow-up of 42.3 months, median overall survival was 21.9 months (95 percent confidence interval 17.7 to 27.0) with FOLFIRINOX against 21.3 months (16.8 to 25.5) with chemoradiotherapy (hazard ratio 0.88, 0.69 to 1.13; p 0.32). Grade 3 or 4 neutropenia was 25 against 22 percent, diarrhoea 23 against 1 percent and leucopenia 8 against 15 percent; serious adverse events 49 against 43 percent; three treatment-related deaths. The trial did not show a difference and the authors concluded that either neoadjuvant regimen may be used. Read with PREOPANC-1 (chemoradiotherapy first beat surgery first at five years) it supports treating before surgery in this Dutch population, while NORPACT-1 argues the opposite for clearly resectable tumours.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-24
- Also known as: PREOPANC 2
- Phase: 3
- Setting: Resectable and borderline resectable pancreatic ductal adenocarcinoma in the Netherlands: eight cycles of neoadjuvant FOLFIRINOX and surgery without adjuvant treatment, against three cycles of neoadjuvant gemcitabine with 36 Gy in 15 fractions during the second, surgery and four cycles of adjuvant gemcitabine, with overall survival as the primary endpoint
- Sponsor: Dutch Pancreatic Cancer Group (Erasmus MC), Dutch Cancer Society and ZonMw
- Enrolled: 375
- Result: Median overall survival 21.9 months with neoadjuvant FOLFIRINOX against 21.3 months with neoadjuvant gemcitabine chemoradiotherapy and adjuvant gemcitabine (hazard ratio 0.88, 95 percent confidence interval 0.69 to 1.13; p 0.32).
- Outcomes: Overall survival (modified intention to treat): Neoadjuvant FOLFIRINOX, surgery 21.9 months vs Neoadjuvant gemcitabine chemoradiotherapy, surgery, adjuvant gemcitabine 21.3 months, HR 0.88

## Sources

- Janssen et al., PREOPANC-2 (Lancet Oncology 2025): https://doi.org/10.1016/S1470-2045(25)00363-8
- EU Clinical Trials Register 2017-002036-17: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002036-17

## Connected records

- cancers: [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [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/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Pancreatic cancer: the failed and stopped programmes and why](https://onco.cc/terms/pancreatic-failed-programmes/)
- drugs: [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/)
- institutions: [Erasmus MC Cancer Institute](https://onco.cc/institutions/erasmus-mc/)
- people: [Marc G. Besselink](https://onco.cc/people/marc-besselink/)
- trials: [ESPAC-5](https://onco.cc/trials/espac-5/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PREOPANC-3](https://onco.cc/trials/preopanc-3/)

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