Neoadjuvant treatment in resectable pancreatic cancer: Why is upfront surgery so hard to be beaten?

Table 1 Studies based on Gemcitabine for adjuvant treatment of resectable pancreatic adenocarcinoma

Ref.	Year	Trial Design	Age (range), years	Intervention	n	Median OS (95%CI), months	OS P value	Median DFS (95%CI), months	DFS P value	R0 rates (%)
CONKO-001[10]	2007	Ph3	62 (34-82)	Gem	179	22.1 (NS)	0.06	13.4 (11.4-15.3)	< 0.01	81
			61 (36-81)	Observation	175	20.2 (NS)		6.9 (6.1-7.8)		85
ESPAC-1[11]	2004	Two-by-two factorial design	62 (52-68)	5-FU+RDT	145	15.9 (13.7-19.9)	0.05	10.7 (8.8-15.5)1	0.04	812
			61 (55-66)	No RDT	144	17.9 (14.8-23.6)		15.2 (9.8-22.2)1		842
			61 (54-67)	5-FU	147	20.1 (16.5-22.7)	0.009	15.3 (10.5-19.2)1	0.02	812
			61 (54-67)	No 5-FU	142	15.5 (13.0-17.7)		9.4 (8.4-15.2)1		842
ESPAC-4[12]	2017	Ph3	65 (37-80)	Gem	366	25.5 (22.7–27.9)	0.03	13.1 (11.6–15.3)3	0.08	402
			65 (39-81)	Gem, Cap	364	28.0 (23.5–31.5)		13.9 (12.1–16.6)3		392
PRODIGE-24[13]	2018	Ph3	63 (30-79)	mFFX	247	54.4 (41.8-NR)	0.003	30.4 (21.7-NR)	< 0.001	59.9
			64 (30-81)	Gem	246	35 (28.7-43.9)		17.7 (14.2-21.5)		54.5
APACT[14]	2023	Ph3	64 (34-83)	Gem, Nab-Pac	432	41.8 (35.5- 47.2)	0.02	16.6 (14.5-19.2)	0.02	76
			64 (38-86)	Gem	434	37.7 (31.1-40.5)		13.7 (11.2-16.0)		77
JASPAC-1[15]	2016	Ph3	66 (59–73)	Gem	190	25.5 (22.5-29.6)	< 0.0001	11.3 (9.7-13.6)	0.0001	86
			66 (60–73)	S-1	187	46.5 (37.8-63.7)		22.9 (17.4–30.6)		88

¹Time-to-tumor recurrence.

²Negative margins.

³Relapse-free survival.

Ph3: Phase 3; Gem: Gemcitabine; 5-FU: Fluorouracil; RDT: Radiotherapy; mFFX: Modified FOLFIRINOX; NR: Not-reached; Nab-Pac: Nab-paclitaxel; NS: No specified.