Parag Roy, Medical Oncologist at Tata Main Hospital shared a post on LinkedIn:
“Exciting breakthrough in pancreatic ductal adenocarcinoma (PDAC) treatment from the CASSANDRA trial!
Key Findings
The phase 3 CASSANDRA trial (PACT-21) compared preoperative PAXG (cisplatin, nab-paclitaxel, capecitabine, gemcitabine) versus mFOLFIRINOX in 260 patients with resectable or borderline resectable stage I-III PDAC.
PAXG significantly prolonged median event-free survival (EFS) to 16.0 months (95% CI 12.4-19.8) compared to 10.2 months (8.6-13.5) with mFOLFIRINOX (HR 0.63, 95% CI 0.47-0.84, p=0.0018).
PAXG also improved disease control rates, CA19-9 responses, pathological complete responses, and reduced intraoperative/early postoperative metastases, without increasing severe toxicity beyond neutropenia.
Clinical Implications
Preoperative PAXG emerges as a new standard for non-metastatic PDAC, outperforming mFOLFIRINOX in EFS and key secondary endpoints across subgroups.
This supports neoadjuvant therapy as standard care, positioning PAXG as the benchmark for future trials in resectable/borderline resectable settings.
Relevance for Oncologists
As a medical oncologist, these results refine our approach to PDAC management, emphasizing tolerable, effective regimens like PAXG to optimize surgical outcomes and delay events.
Full details published in The Lancet (Nov 20, 2025)
What are your thoughts on integrating PAXG into practice? Let’s discuss!”
Title: Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2 × 2 factorial phase 3 trial
Authors: Michele Reni, Marina Macchini, Giulia Orsi, Letizia Procaccio, Giuseppe Malleo, Catia Carconi, Ilario Giovanni Rapposelli, Katia Bencardino, Mario Scartozzi, Gianpaolo Balzano, Domenico Tamburrino, Barbara Merelli, Elisa Sperti, Giulio Belfiori, Nicole Liscia, Silvia Bozzarelli, Mariacristina Di Marco, Emiliano Tamburini, Michele Milella, Sara Lonardi, Giorgio Ercolani, Michele Mazzola, Diego Palumbo, Valter Torri, Massimo Falconi
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