Trial reportThe Lancet. Oncology2025
Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial.
Trial report in The Lancet. Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of R0/R1 Margin Status on Overall Survival in Node-Positive Resected Pancreatic Ductal Adenocarcinoma: Meta-Analysis.Annals of surgical oncology · 2026Pooled it
- Neoadjuvant Treatment Versus Upfront Surgery for Resectable Pancreatic Ductal Adenocarcinoma-A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Medicina (Kaunas, Lithuania) · 2026Pooled it
- [Combination of radiotherapy and medicinal anticancer therapy with curative intent].Radiologie (Heidelberg, Germany) · 2026Article
- TMPRSS4 Expression Predicts Survival and Benefit from Neoadjuvant Chemotherapy in Pancreatic Cancer.Annals of surgical oncology · 2026Article
- Impact of Neoadjuvant Approach and Tumor Response on Survival in Pancreatic Adenocarcinoma.Journal of surgical oncology · 2026Article
- Editorial for PREOPANC-2, a multicenter, open-label, phase 3 randomized trial comparing neoadjuvant FOLFIRINOXHepatobiliary surgery and nutrition · 2026Article
- Borderline resectable pancreatic ductal adenocarcinoma: a narrative review.Annals of medicine and surgery (2012) · 2026Review
- Neoadjuvant Early Stereotactic Body Radiation Therapy Followed by Chemoimmunotherapy in Borderline Resectable and Locally Advanced Pancreatic Cancer.Advances in radiation oncology · 2026Article
- Beyond tumor biology: can host nutritional status refine prediction of early recurrence after pancreatic cancer surgery?Gland surgery · 2026Article
- Beyond Surgery: Does Adjuvant Therapy Still Add Value for Patients With Pancreatic Cancer After Neoadjuvant Treatment?Annals of surgical oncology · 2026Article
- Global Perspectives on Radiotherapy Utilization for Pancreatic Ductal Adenocarcinoma.Journal of gastrointestinal cancer · 2026Article
- Challenges and opportunities in combining radiotherapy and immunotherapy for localized pancreatic cancer.Nature reviews. Gastroenterology & hepatology · 2026Review
- Article
- Review
- Dual-energy CT extracellular volume fraction for predicting the chemotherapeutic response in pancreatic ductal adenocarcinoma.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Article
- Association of Cancer Center Designation with Multimodality Treatment, Perioperative Outcomes, and Survival among Older Adults with Pancreatic Ductal Adenocarcinoma.Annals of surgical oncology · 2026Article
- Review
- Pancreatic Cancer: Translating Tumor Biology into Actionability.Cancer discovery · 2026Review
- Real-world feasibility and safety of neoadjuvant FOLFIRINOX in pancreatic ductal adenocarcinoma: a retrospective single-center study.Journal of gastrointestinal oncology · 2026Article
- Benefit of Adjuvant Therapy After Neoadjuvant Therapy and Resection for Patients with Pancreatic Cancer: A Systematic Review and Meta-analysis.Annals of surgical oncology · 2026Article
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Authors and funding
40 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe PREOPANC-2 trial aimed to evaluate whether neoadjuvant FOLFIRINOX improved overall survival compared with neoadjuvant gemcitabine-based chemoradiotherapy followed by adjuvant gemcitabine in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC).
methodsIn this investigator-initiated, open-label, nationwide, phase 3 randomised trial, patients aged 18 years or older with resectable or borderline resectable PDAC and a WHO performance status of 0 or 1 were enrolled across 19 Dutch centres. Patients in the FOLFIRINOX (FFX) group received FOLFIRINOX (85 mg/m
findingsFrom June 5, 2018, to Jan 28, 2021, 375 patients were randomly assigned to the FFX group (n=188) or the CRT group (n=187). Six patients (three per group) were excluded due to ineligibility (n=4) or immediate withdrawal of informed consent after randomisation (n=2). 208 (56%) of 369 patients were male and 161 (44%) were female. After a median follow-up of 42·3 months (IQR 35·7-48·7), median overall survival was 21·9 months (95% CI 17·7-27·0) in the FFX group versus 21·3 months (16·8-25·5) in the CRT group (HR 0·88 [95% CI 0·69-1·13], p=0·32). The most common grade 3-4 adverse events were neutropenia (43 [25%] of 175 in the FFX group vs 38 [22%] of 176 in the CRT group), diarrhoea (41 [23%] vs two [1%]), and leukopenia (14 [8%] vs 26 [15%]). Serious adverse events occurred in 85 (49%) patients in the FFX group compared with 75 (43%) in the CRT group (p=0·26). Adverse events of grades 3 or worse occurred in 117 (67%) patients in the FFX group versus 106 (60%) patients in the CRT group (p=0·20). Treatment-related deaths occurred in two (1%) patients in the FFX group (multi-organ failure and intestinal mucositis) and one (1%) patient in the CRT group (upper gastrointestinal haemorrhage).
interpretationThis randomised trial did not show a difference in overall survival between neoadjuvant FOLFIRINOX and neoadjuvant gemcitabine-based chemoradiotherapy in patients with resectable or borderline resectable PDAC. Both neoadjuvant treatment regimens may be considered in these patients.
fundingDutch Cancer Society and ZonMw.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.