{"entity":{"id":"paper-espac-5-neoadjuvant-borderline-resectable-ghaneh-lancet-gastroenterol-hepatol-2023","kind":"paper","name":"ESPAC-5: immediate surgery versus short-course neoadjuvant chemotherapy or chemoradiotherapy in borderline resectable pancreatic cancer","aka":[],"tldr":"In borderline resectable pancreatic cancer, two months of chemotherapy before surgery did not change how many tumours could be removed but was followed by far better one-year survival than going straight to surgery.","summary":"Four-arm randomised phase 2 feasibility trial at 16 sites: 90 patients with borderline resectable pancreatic cancer were randomised to immediate surgery (33), neoadjuvant gemcitabine plus capecitabine (20), FOLFIRINOX (20) or capecitabine-based chemoradiotherapy (17); 86 were analysed.\n\nResection rates were 68 percent after immediate surgery and 55 percent after neoadjuvant therapy (p 0.33), with R0 rates of 14 and 23 percent. One-year overall survival was 39 percent with immediate surgery against 78, 84 and 60 percent in the three neoadjuvant arms (p 0.0028); one-year disease-free survival from surgery was 33 against 59 percent (hazard ratio 0.53).","asOf":"2026-09-22","links":[{"label":"Lancet Gastroenterol Hepatol 2023","url":"https://doi.org/10.1016/S2468-1253(22)00348-X"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/36521500/"}],"tags":[],"related":[],"cancers":["borderline-resectable-pdac","pancreatic"],"sections":[],"technologies":[],"targets":[],"drugs":["gemcitabine","capecitabine","folfirinox"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["espac-5"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"The Lancet Gastroenterology and Hepatology","year":2023,"doi":"10.1016/S2468-1253(22)00348-X","pmid":"36521500","authors":"Ghaneh P, Palmer D, Cicconi S, et al.","paperType":"rct","findings":["One-year overall survival 39 percent (95% CI 24 to 61) with immediate surgery versus 78 percent (gemcitabine plus capecitabine), 84 percent (FOLFIRINOX) and 60 percent (chemoradiotherapy); p 0.0028.","Resection 68 versus 55 percent (p 0.33); R0 resection 14 versus 23 percent (p 0.49).","One-year disease-free survival from surgery 33 versus 59 percent; hazard ratio 0.53 (0.28 to 0.98), p 0.016."],"whatItMeans":"Supports neoadjuvant therapy, preferably chemotherapy, for borderline resectable pancreatic cancer while larger trials define the regimen.","caveats":["Feasibility design with small arms and a survival difference that was a secondary outcome.","Median follow-up only 12.2 months."],"changedPractice":true,"participants":90},"route":"/key-papers/paper-espac-5-neoadjuvant-borderline-resectable-ghaneh-lancet-gastroenterol-hepatol-2023/","neighbours":{"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"drug":[{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"folfirinox","kind":"drug","name":"FOLFIRINOX / mFOLFIRINOX","route":"/drugs/folfirinox/"},{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"}],"trial":[{"id":"espac-5","kind":"trial","name":"ESPAC-5","route":"/trials/espac-5/"}]}}