Analyzing the ESPAC-5F Trial in Borderline Resectable Pancreatic Cancer

Shubham Pant, MD, an associate professor in the Department of Investigational Cancer Therapeutics and the Department of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center, discusses the ESPAC-5F trial (ISRCTN89500674) methods and efficacy in patients with pancreatic cancer.

This was a prospective, multicenter, randomized phase 2 study with 4 arms for patients with borderline resectable pancreatic cancer. According to Pant, this type of cancer touches some vessels in the patient but does not encase these vessels. The patients either received immediate surgery or neoadjuvant gemcitabine (Gemzar) plus capecitabine (Xeloda) or FOLFIRINOX (folnic acid, fluorouracil, irinotecan, and oxaplatin) or chemoradiotherapy. For the surgery arm, there were 32 patients; 20 were on the gemcitabine and capecitabine regimen, 20 were on the FOLFIRINOX regimen, and 16 patients received chemoradiation.

The investigators found that the 1-year survival rate was 77% for patients receiving neoadjuvant therapy and 40% for those receiving immediate surgery. Pant says this is important because pancreatic cancer is a systemic disease and the micrometastases need to be killed before for patients go in for surgery. Neoadjuvant therapy should be given to most patients who have this disease, and he thinks this should be the standard for most, if not all patients in this setting.

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