Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Pancreatic Adenocarcinoma: Long-Term Outcomes of Adjuvant Therapy in the ESPAC4 Phase III Trial,” published in the December 2024 issue of Oncology by Palmer et al.    

The ESPAC4 trial showed that adjuvant chemotherapy with gemcitabine (GEM) plus capecitabine (GemCap) improved overall survival (OS) compared to GEM alone in people with pancreatic adenocarcinoma. In addition, the PRODIGE24-CCTG PA.6 trial found that modified fluorouracil, folinic acid, irinotecan, and oxaliplatin (mFOLFIRINOX) provided even longer survival, although it had more restrictive eligibility criteria. 

Researchers conducted a retrospective study to evaluate long-term OS outcomes in the ESPAC4 trial.  

They analyzed OS in 732 people from the ESPAC4 trial, comparing 367 people treated with GEM to 365 people treated with GemCap after a median follow-up of 104 months (101-108) and 566 deaths.  

The results showed a median OS of 29.5 months (27.5-32.1), the GEM group had a median survival of 28.4 months (25.2-32.0), and the GemCap group had 31.6 months (26.5-38.0) (HR, 0.83 [0.71 to 0.98]; P=.031). Among people with R0 resection, the GEM group had a median survival of 32.2 months (27.9-41.6) compared with 49.9 months (39.0-82.3) for GemCap (HR, 0.63 [0.47 to 0.84]; P=.002). People with lymph node-negative status had a higher 5-year survival rate with GemCap (59% [49%-71%]) than with GEM (53% [42%-66%]; HR, 0.63 [0.41 to 0.98]; P=.04), while no significant difference was found in people with lymph node-positive status (P=.225). In the subgroup of 193 people ineligible for the PRODIGE24 trial, GemCap showed a survival advantage (median survival of 25.9 months [22.3-30.2]) compared to GEM (median survival of 20.7 months [16.2-27.3]) (HR, 0.71 [95% CI, 0.52 to 0.98]; χ^{2_log-rank-1df} = 4.31; P=.038).  

They concluded that GemCap was a standard option for people with pancreatic adenocarcinoma who are not eligible for mFOLFIRINOX, particularly for those with R0 resection or lymph node-negative status.  

Source: ascopubs.org/doi/10.1200/JCO.24.01118