{"entity":{"id":"espac-1","kind":"trial","name":"ESPAC-1","aka":["ESPAC1","European Study Group for Pancreatic Cancer trial 1"],"tldr":"ESPAC-1 is the 2004 trial that made chemotherapy after pancreatic cancer surgery standard and pushed radiotherapy out: five-year survival was 21 percent with chemotherapy against 8 percent without, while chemoradiotherapy lowered it from 20 to 10 percent.","summary":"ESPAC-1 randomised 289 patients with resected pancreatic ductal adenocarcinoma in a two-by-two factorial design; the final analysis (median follow-up 47 months, 237 deaths) gave an estimated five-year survival of 21 percent among patients who received chemotherapy against 8 percent among those who did not (p 0.009), and 10 percent among those who received chemoradiotherapy against 20 percent among those who did not (p 0.05), the chemotherapy benefit persisting after adjustment for prognostic factors. The authors concluded that adjuvant chemotherapy has a significant survival benefit whereas adjuvant chemoradiotherapy is deleterious, a conclusion that separated European practice (chemotherapy alone: ESPAC-3, ESPAC-4, PRODIGE 24) from the North American use of adjuvant chemoradiotherapy for a decade and that the negative LAP07 and CONKO-007 results later echoed in the locally advanced setting. Its split-course 20 Gy radiotherapy and lack of quality assurance were criticised at the time, but no later randomised trial has shown adjuvant chemoradiotherapy improves survival.","status":"mixed","asOf":"2026-09-24","links":[{"label":"Neoptolemos et al., a randomised trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer, ESPAC-1 (NEJM 2004)","url":"https://doi.org/10.1056/NEJMoa032295"}],"tags":[],"related":[],"cancers":["pancreatic","resectable-pdac"],"sections":[],"technologies":["cytotoxic-chemotherapy","chemoradiation"],"targets":[],"drugs":["fluorouracil","leucovorin"],"companies":[],"institutions":["cruk"],"pathways":[],"terms":["neoadjuvant-adjuvant","chemoradiation","pancreatic-failed-programmes"],"trials":["espac-3","espac-4","conko-001"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"phase":"3","setting":"Resected pancreatic ductal adenocarcinoma in Europe: a two-by-two factorial randomisation to adjuvant chemoradiotherapy (20 Gy over two weeks with fluorouracil), adjuvant chemotherapy (fluorouracil and folinic acid), both, or observation, with overall survival as the primary endpoint","sponsor":"European Study Group for Pancreatic Cancer (University of Liverpool), Cancer Research UK","result":"Five-year survival 21 percent with adjuvant chemotherapy against 8 percent without (p 0.009); 10 percent with chemoradiotherapy against 20 percent without (p 0.05).","yearReported":2004,"enrolled":289,"enrolledBasis":"randomised","enrolledNote":"ESPAC-1 predates the trial registries and has no ClinicalTrials.gov or ISRCTN record; 289 is the number randomised in the two-by-two factorial design reported in the NEJM 2004 final analysis (73 chemoradiotherapy, 75 chemotherapy, 72 both, 69 observation).","outcomes":[{"endpoint":"Overall survival at 5 years, chemotherapy factor","primary":true,"unit":"%","arms":[{"name":"Adjuvant fluorouracil and folinic acid (with or without chemoradiotherapy)","n":147,"value":21},{"name":"No chemotherapy","n":142,"value":8}],"p":"0.009","source":"https://doi.org/10.1056/NEJMoa032295"},{"endpoint":"Overall survival at 5 years, chemoradiotherapy factor","unit":"%","arms":[{"name":"Adjuvant chemoradiotherapy (with or without chemotherapy)","n":145,"value":10},{"name":"No chemoradiotherapy","n":144,"value":20}],"p":"0.05","source":"https://doi.org/10.1056/NEJMoa032295"}]},"route":"/trials/espac-1/","neighbours":{"cancer":[{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"term":[{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"},{"id":"pancreatic-failed-programmes","kind":"term","name":"Pancreatic cancer: the failed and stopped programmes and why","route":"/terms/pancreatic-failed-programmes/"}],"drug":[{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"leucovorin","kind":"drug","name":"Leucovorin (folinic acid)","route":"/drugs/leucovorin/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"}],"trial":[{"id":"conko-001","kind":"trial","name":"CONKO-001","route":"/trials/conko-001/"},{"id":"espac-3","kind":"trial","name":"ESPAC-3","route":"/trials/espac-3/"},{"id":"espac-4","kind":"trial","name":"ESPAC-4","route":"/trials/espac-4/"}]}}