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CONKO-007 is the largest test of radiotherapy after chemotherapy for pancreatic cancer that cannot be removed at diagnosis: chemoradiotherapy did not raise the share of all patients reaching a clear-margin operation (25 against 18 percent) or lengthen survival, but among those operated the margins were clear more often (69 against 50 percent).
CONKO-007 enrolled 525 patients with unresectable tumours; after three months of induction 336 were randomised to continue the same chemotherapy (167) or to chemoradiotherapy (169). Slow recruitment led the investigators to change the primary endpoint from overall survival to the overall R0 resection rate after an interim analysis; median follow-up was 76 months. R0 resection was achieved in 25 percent (43 of 169) after chemoradiotherapy against 18 percent (30 of 167) after chemotherapy (p 0.113), not significant; surgery was performed equally often and among operated patients the R0 rate was 69.4 against 50.0 percent (p 0.04), with the R0/R1/R2/no-resection distribution also favouring chemoradiotherapy (p 0.02). Overall survival did not differ (hazard ratio 0.937, 95 percent confidence interval 0.747 to 1.174; p 0.57) while surgery itself was associated with longer survival (hazard ratio 0.525). Letters in JCO 2026 debated the endpoint change and the gemcitabine radiosensitiser; the corpus reads it with LAP07 (no survival gain, better local control) and SCALOP (capecitabine as the preferred radiosensitiser).
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
336 randomised.
43 of 169 · 30 of 167
SourceMedians not given in the abstract
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| R0 resection rate, all randomised patientsprimary | Induction chemotherapy then chemoradiotherapy | 169 | 25% | - | 0.113 | link |
| Continued chemotherapy | 167 | 18% | ||||
| Overall survival (randomised intention to treat) | Induction chemotherapy then chemoradiotherapy | 169 | Medians not given in the abstract | 0.937 (0.747 to 1.174) | 0.57 | link |
| Continued chemotherapy | 167 | - |
Shares Resectable, borderline resectable and unresectable, Resection margins (R0 / R1 / R2), Pancreatic cancer: the failed and stopped programmes and why, FOLFIRINOX / mFOLFIRINOX.
Shares LAP07, Chemoradiation (chemoradiotherapy, CRT), Locally advanced unresectable pancreatic ductal adenocarcinoma, Gemcitabine.
Shares Resectable, borderline resectable and unresectable, FOLFIRINOX / mFOLFIRINOX, Locally advanced unresectable pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares LAP07, Locally advanced unresectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma.
Shares Locally advanced unresectable pancreatic ductal adenocarcinoma, Gemcitabine, Cytotoxic chemotherapy, Pancreatic ductal adenocarcinoma.
Shares Locally advanced unresectable pancreatic ductal adenocarcinoma, Gemcitabine, Cytotoxic chemotherapy, Pancreatic ductal adenocarcinoma.
Shares Locally advanced unresectable pancreatic ductal adenocarcinoma, Gemcitabine, Cytotoxic chemotherapy, Pancreatic ductal adenocarcinoma.
Shares Resectable, borderline resectable and unresectable, Chemoradiation (chemoradiotherapy, CRT), Locally advanced unresectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma.