Blood PACT.

That's not what these authors had with their funders. The phase 2 component of the Italian trial PACT-15 was designed to assess a benefit with neoadjuvant chemo for early stage I-II pancreatic cancer. 89 patients with resectable disease were randomized to one of three arms: [1] surgery → adjuvant gemcitabine, [2] surgery → adjuvant cisplatin/ epirubicin/ capecitabine/ gem (PEXG) x 6, or [3] sandwich PEXG x 3 → surgery → PEGX x 3. Reported event free survival rates at one year were 6/30 (23%) in arm 1, 15/30 (50%) in arm 2, and 19/29 (66%) in arm 3. Median survival times were 20, 26, and 38 months, respectively. While small, these numbers show a remarkable trend in favor of the neoadjuvant approach and certainly support moving forward with the phase 3 component. Except, plot twist, the authors decided not to. Instead they're abandoning their tested regimens altogether in favor of in vogue chemo not appreciated back in 2010 when this trial was designed (read: abraxane or FOLFIRINOX). TBL:Neoadjuvant chemo looks promising for pancreatic cancer, even for upfront resectable disease. | Reni, Lancet Gastroenterol Hepatol 2018


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