PREOPANC long-term results: neoadjuvant gemcitabine-based chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer
Giving chemotherapy and radiotherapy before the operation, rather than operating first, tripled the share of patients alive at five years in this Dutch trial, with the gain clearest in borderline resectable tumours. It is the strongest randomised case for treating borderline resectable pancreatic cancer before surgery.
Overview
Long-term analysis of the Dutch Pancreatic Cancer Group's randomised phase 3 PREOPANC trial, in which 246 patients with resectable or borderline resectable pancreatic cancer were assigned to neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine, or to immediate surgery followed by adjuvant gemcitabine.
With a median follow-up of 59 months, overall survival favoured the neoadjuvant arm (hazard ratio 0.73), with five-year survival of 20.5 percent against 6.5 percent even though median survival differed by little (15.7 against 14.3 months). The benefit was significant in the borderline resectable subgroup and consistent across the others. The 2020 primary report had shown better R0 resection rates and disease-free survival without a significant overall survival difference.
- Overall survival hazard ratio 0.73 favouring neoadjuvant chemoradiotherapy; five-year survival 20.5 versus 6.5 percent.
- Median overall survival 15.7 versus 14.3 months, so the benefit sits in the tail of the curve.
- Significant benefit in the borderline resectable subgroup.
Neoadjuvant treatment is now the standard for borderline resectable pancreatic cancer, and PREOPANC is the trial guidelines cite; the follow-on PREOPANC-2 tested FOLFIRINOX in the same setting.
- Gemcitabine-based chemoradiotherapy is no longer the preferred neoadjuvant regimen; most centres use FOLFIRINOX-based chemotherapy.
- Median survival in both arms was short by today's standards, and the trial was small.
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