Journal of surgical oncology
October 12, 2026 · via Europe PMC
Chemotherapy After Resection of Pancreatic Ductal Adenocarcinoma: Impact of Different Regimens in a Real-World Population.
Biesma NC, Cirkel GA, Haj Mohammad N, Los M, Verdonk RC, Molenaar IQ, Daamen LA, van Santvoort HC
AI summary — for doctors, generated from the abstract only
In a single-centre Dutch cohort, the survival advantage of adjuvant (m)FOLFIRINOX seen in PRODIGE 24 was not reproduced in routine practice.
What was studied
Post-hoc analysis of a prospectively maintained cohort of 161 patients who had pancreatic ductal adenocarcinoma resected in Utrecht (2016-2020), comparing adjuvant chemotherapy regimens and trial-eligible subsets with Kaplan-Meier and Cox models.
Key findings
- Median follow-up was 51 months.
- Patients on (m)FOLFIRINOX (n=30) had a median overall survival of 29 months, far below the trial figure.
- The authors report no survival benefit for this regimen over other adjuvant regimens in this cohort, including the trial-eligible subgroup.
Clinical relevance
Real-world outcomes after resected PDAC may be less favourable than trial results, which matters when counselling patients about expected benefit from adjuvant (m)FOLFIRINOX.
Who should care
Limitations
Single-centre, non-randomised analysis with only 30 patients on (m)FOLFIRINOX, so confounding and low power are likely; part of the abstract was cut off.
Interpret trial survival figures cautiously when counselling patients, and note that this small cohort does not by itself argue against using (m)FOLFIRINOX.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
INTRODUCTION
The PRODIGE 24/CCTG PA.6- trial has shown an overall survival (OS) up to 55 months in patients treated with (modified) 5-fluorouracil, leucovorin, irinotecan and oxaliplatin ((m)FOLFIRINOX) chemotherapy after resection of pancreatic ductal adenocarcinoma (PDAC). The applicability of these results to a real-world patient population is, however, unknown. This study aimed to assess the efficacy of (m)FOLFIRINOX compared to other adjuvant chemotherapy regimens in a real-world cohort.
METHODS
We performed a post-hoc analysis in a prospectively maintained cohort of patients undergoing PDAC resection in the Regional Academic Cancer Centre Utrecht, the Netherlands, from 2016 to 2020. Median OS was evaluated using Kaplan-Meier curves, primarily stratified by adjuvant chemotherapy regimen and secondarily by eligibility for the PRODIGE 24/CCTG PA.6- trial. Multivariable Cox regression was used to assess the association between chemotherapy regimen and OS, presented as hazard ratio's (HR) with 95% confidence interval (95%CI).
RESULTS
A total of 161 patients with a median follow-up of 51 months (interquartile range (IQR) 43-61) were included. With (m)FOLFIRINOX (n = 30), OS was 29 months (IQR 22-42; [HR 0.26, 95%CI 0.14-0.47, p < 0.01]). Comparing (m)FOLFIRINOX with gemcitabine monotherapy yielded a HR of 0.62 (95%CI 0.33-1.17, p = 0.14), while (m)FOLFIRINOX versus gemcitabine combination therapy had a HR of 0.66 (95% CI 0.35-1.24 p = 0.20). Patients without adjuvant therapy (n = 71) had a median OS of 13 months (IQR 11-23, reference group). In patients receiving gemcitabine monotherapy (n = 31), median OS was 21 months (IQR 15-31; [HR 0.41 95%CI 0.25-0.69, p < 0.01]); for gemcitabine combination therapy (n = 29), OS was 28 months (IQR 23-43; [HR 0.39, 95%CI 0.23-0.66, p < 0.01]) In patients who received (m)FOLFIRINOX and who did or did not meet trial eligibility criteria, OS was 27 months (IQR 12-NR), compared to 30 months (IQR 21-NR) (p = 0.16), respectively.
CONCLUSION
The survival benefit of (m)FOLFIRINOX observed in the clinical trial setting was not observed in our real-world cohort, not even in the selected subset of patients who would have deemed eligible for inclusion in the PRODIGE 24/CCTG PA.6- trial. Survival was not different for patients treated with (m)FOLFIRINOX and gemcitabine combination therapy.
DOI
10.1002/jso.70391
PMID
42861545
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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