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The 2020 primary report of the Dutch PREOPANC trial: giving chemotherapy and radiotherapy before surgery did not significantly lengthen survival overall, but it raised clear-margin resections from 40 to 71 percent and helped the patients whose tumours were borderline operable.
PREOPANC randomised 246 patients with resectable or borderline resectable pancreatic cancer at 16 Dutch centres between April 2013 and July 2017 to preoperative chemoradiotherapy (three courses of gemcitabine, the second with 15 fractions of 2.4 Gy, then surgery and four courses of adjuvant gemcitabine; 119 patients) or immediate surgery followed by six courses of adjuvant gemcitabine (127). Median overall survival by intention to treat was 16.0 versus 14.3 months (hazard ratio 0.78, 95 percent confidence interval 0.58 to 1.05, P = 0.096). The resection rate was 61 versus 72 percent; the R0 rate 71 percent (51 of 72) versus 40 percent (37 of 92), P less than 0.001. Preoperative treatment was associated with better disease-free survival and locoregional failure-free interval and fewer positive nodes, perineural and venous invasion; serious adverse events occurred in 52 versus 41 percent. The long-term analysis (2022, recorded separately) showed a survival benefit at five years.
The trial that made neoadjuvant treatment standard for borderline resectable disease and opened the still unresolved question for resectable disease, which PREOPANC-2, NORPACT-1, PREOPANC-3 and Alliance A021806 inherited.
Together with NORPACT-1 this left the neoadjuvant question for resectable disease open: FOLFIRINOX before surgery is not proven superior to alternatives, and the comparison against upfront surgery with adjuvant modified FOLFIRINOX is what PREOPANC-3 and Alliance A021806 are running.
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.
Shares Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial, Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed, Neoadjuvant / adjuvant / perioperative, Resectable pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Journal of Clinical Oncology and the tag pancreatic-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Cytotoxic chemotherapy and the tag pancreatic-evidence.
Shares Resectable, borderline resectable and unresectable, Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Gemcitabine, Cytotoxic chemotherapy and the tag pancreatic-evidence.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Journal of Clinical Oncology, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.