Neo-adjuvant FOLF(IRIN)OX for Resectable Pancreatic Adenocarcinoma

NCT02959879 | Completed Phase 2 DMC

• 1 other identifier: 2014/0210/HP
• Study Type: interventional
• Target: 153
• Locations: 1 country
• Sites: 1

Brief Summary

In patients with resectable pancreatic duct adenocarcinoma (PDAC), curative surgery followed by adjuvant chemotherapy is currently the standard of care. However, the long-term results are still poor, with median disease-free and overall survival of 14 months and 23 months. The corresponding 5-year overall survival rate is 20%. Chemotherapy before surgery (neoadjuvant chemotherapy) allows identification of patients with rapidly progressive metastatic disease at time of preoperative restaging (surgery is then avoided in these patients), and may increase the rate of free margin resection (R0) and reduce the risk of local recurrence. Even though single-agent gemcitabine and 5-FU have been validated in adjuvant and metastatic settings, the objective response was low (at around 10%), whereas combination chemotherapy exceeds a response rate of 30% in advanced disease. In metastatic PDAC, palliative FOLFIRINOX chemotherapy has been demonstrated to be effective (in terms of response rates and progression-free survival) and well tolerated. Interestingly, the response rate is increased by using more than two chemotherapeutic agents in advanced pancreatic cancer, justifying the use of an alternative neoadjuvant FOLFOX-based chemotherapy arm. PANACHE-01 is an open, non-comparative, randomised, multicentre Phase II study designed to assess the safety and efficacy of two modes of neo-adjuvant chemotherapy (FOLFIRINOX \& FOLFOX) relative to the current reference treatment (surgery and then adjuvant chemotherapy) for resectable PDAC. Patients with immediately resectable PDAC (definition based on the NCCN's (American National Comprehensive Cancer Network 2014) latest guidelines) will be randomised to either pancreatectomy and adjuvant chemotherapy or 4 cycles of neoadjuvant chemotherapy with either FOLFOX or FOLFIRINOX. The patients in the neoadjuvant chemotherapy arms will receive postoperative chemotherapy for 4 months (8 cycles).

Conditions

Resectable Pancreatic Duct Adenocarcinoma

Keywords

FOLFOX; FOLFIRINOX

Outcome Measures

Primary Outcomes (2)

• Number of patients alive

  Number of patients alive is evaluated 12 months after the surgery

  12 months

• Number of patients who achieved the complete chemotherapy treatment sequences

  The number of patients who achieved the complete chemotherapy treatment sequences is evaluated 12 months after the surgery

  12 months

Secondary Outcomes (6)

• Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

  through end of treatment, an average of 12 months

• Number of post-operative complications

  1 month after surgery

• Number of patients alive and without recurrence

  36 months

• Number of accomplished R0 resection surgery

  Surgery day

• Evaluation of quality of life

  4 weeks after the end of chemotherapy treatment

Study Arms (3)

FOLFOX neoadjuvant chemotherapy

EXPERIMENTAL

4 cycles of FOLFOX neoadjuvant chemotherapy are administrated to patient. Curative surgery for resectable pancreatic duct adenocarcinoma will be done after neoadjuvant chemotherapy. 8 cycles of adjuvant chemotherapy are administrated following the surgery

Drug: FOLFOX neoadjuvant chemotherapy; Procedure: curative surgery for resectable pancreatic duct adenocarcinoma; Drug: adjuvant chemotherapy

FOLFIRINOX neoadjuvant chemotherapy

EXPERIMENTAL

4 cycles of FOLFIRINOX neoadjuvant chemotherapy are administrated to patient. Curative surgery for resectable pancreatic duct adenocarcinoma will be done after neoadjuvant chemotherapy. 8 cycles of adjuvant chemotherapy are administrated following the surgery

Drug: FOLFIRINOX neoadjuvant chemotherapy; Procedure: curative surgery for resectable pancreatic duct adenocarcinoma; Drug: adjuvant chemotherapy

standard adjuvant chemotherapy

ACTIVE COMPARATOR

Curative surgery for resectable pancreatic duct adenocarcinoma will be done after randomization. 12 cycles of standard adjuvant chemotherapy are administrated following the surgery

Procedure: curative surgery for resectable pancreatic duct adenocarcinoma; Drug: Standard adjuvant chemotherapy

Interventions

FOLFOX neoadjuvant chemotherapy DRUG

4 cycles of FOLFOX neoadjuvant chemotherapy are administrated to patient

FOLFOX neoadjuvant chemotherapy

FOLFIRINOX neoadjuvant chemotherapy DRUG

4 cycles of FOLFIRINOX neoadjuvant chemotherapy are administrated to patient

FOLFIRINOX neoadjuvant chemotherapy

curative surgery for resectable pancreatic duct adenocarcinoma PROCEDURE

curative surgery for resectable pancreatic duct adenocarcinoma

FOLFIRINOX neoadjuvant chemotherapy; FOLFOX neoadjuvant chemotherapy; standard adjuvant chemotherapy

Standard adjuvant chemotherapy DRUG

12 cycles of standard adjuvant chemotherapy are administrated

standard adjuvant chemotherapy

adjuvant chemotherapy DRUG

8 cycles of standard adjuvant chemotherapy are administrated

FOLFIRINOX neoadjuvant chemotherapy; FOLFOX neoadjuvant chemotherapy

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histology-proven, adenocarcinoma of the pancreas.
• Resectable adenocarcinoma (according to the NCCN classification 2014): absence of distant organ or distal lymph node metastases, absence of evidence of superior mesenteric vein (SMV) and portal vein distortion, tumour thrombus, or venous encasement, the existence of clear fat planes around the celiac axis, hepatic artery and superior mesenteric artery (SMA). Resectability is evaluated on arterial-phase and portal-phase IV contrast-enhanced multislice CT-scan of the pancreas (slice thickness: 2.5 mm), as evaluated in a multidisciplinary staff meeting including at least one radiologist and one expert surgeon.
• No prior chemotherapy.
• Age 18 years or over.
• Ability to understand and willingness to consent to formal requirements for study participation
• Provision of written informed consent prior to any study-specific screening procedures.

You may not qualify if:

• PDAC defined as "borderline", locally advanced, non-resectable or metastatic.
• Prior cancer therapy for PDAC
• Surgical or anaesthesiological contra-indications: non-controlled congestive heart failure - non-treated angina - recent myocardial infarction (in the previous year) - non-controlled arterial hypertension (SBP \>160 mm or DBP \> 100 mm, despite optimal drug treatment), long QT, major non-controlled infection, severe liver failure.
• Any medical, psychological or social situation that (in the investigator's opinion) could limit (i) the patient's compliance with the protocol or (ii) the ability to obtain or interpret data.
• Pregnant or breastfeeding women and women of child-bearing age not using effective means of contraception.
• History or current evidence on physical examination of central nervous system disease or peripheral neuropathy ≥ grade 1, according to according to Common Terminology Criteria for Adverse Events (CTCAE) v.4.0.
• Known hypersensitivity reaction to any of the components of study treatments.
• Pregnancy (the absence of which must be confirmed in a ß-hCG test) or breast-feeding.
• Any significant disease which, in the investigator's opinion, would exclude the patient from the study.
• Patients having been included in a clinical trial within the previous 4 weeks or participating in another trial.

Sponsors & Collaborators

• GERCOR - Multidisciplinary Oncology Cooperative Group: collaborator
• University Hospital, Rouen: lead
• UNICANCER: collaborator
• Federation Francophone de Cancerologie Digestive: collaborator
• Federation of Research in Surgery (FRENCH): collaborator

Study Sites (1)

Rouen University Hospital

Rouen, France

Location

Related Publications (2)

• Schwarz L, Bachet JB, Meurisse A, Bouche O, Assenat E, Piessen G, Hammel P, Regenet N, Taieb J, Turrini O, Paye F, Turpin A, Souche FR, Laurent C, Kianmanesh R, Michel P, Vernerey D, Mabrut JY, Turco C, Truant S, Sa Cunha A; PANACHE01-FRENCH08-PRODIGE48 Investigators. Neoadjuvant FOLF(IRIN)OX Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Multicenter Randomized Noncomparative Phase II Trial (PANACHE01 FRENCH08 PRODIGE48 study). J Clin Oncol. 2025 Jun 10;43(17):1984-1996. doi: 10.1200/JCO-24-01378. Epub 2025 Apr 4.

  PMID: 40184561 DERIVED

• Schwarz L, Vernerey D, Bachet JB, Tuech JJ, Portales F, Michel P, Cunha AS. Resectable pancreatic adenocarcinoma neo-adjuvant FOLF(IRIN)OX-based chemotherapy - a multicenter, non-comparative, randomized, phase II trial (PANACHE01-PRODIGE48 study). BMC Cancer. 2018 Jul 24;18(1):762. doi: 10.1186/s12885-018-4663-4.

  PMID: 30041614 DERIVED

MeSH Terms

Interventions

Chemotherapy, Adjuvant

Intervention Hierarchy (Ancestors)

Combined Modality Therapy; Therapeutics; Drug Therapy

Study Officials

• Lilian SCHWARZ, MD

  University Hospital, Rouen

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 3, 2016
• First Posted: November 9, 2016
• Study Start: March 1, 2017
• Primary Completion: August 8, 2023
• Study Completion: August 8, 2023
• Last Updated: February 6, 2026

Record last verified: 2018-04

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)