ESPAC-5F

ISRCTN89500674 📎

Regimen

Experimental
Three neoadjuvant arms: (a) GemCap x 2 cycles; (b) FOLFIRINOX x 4 cycles; (c) capecitabine-based chemoradiation 50.4 Gy / 28 fx + capecitabine 830 mg/m2 BID.
Control
Immediate surgery (no neoadjuvant).

Population

Borderline resectable PDAC, UK/German multicenter (16 centers), ECOG 0-1, randomized 1:1:1:1 to 4 arms.

Key finding

ESPAC-5F provided the first UK-German randomized evidence that any neoadjuvant therapy — particularly FOLFIRINOX or GemCap — dramatically improves 1-year OS over immediate surgery in borderline resectable PDAC, despite similar resection rates (55% vs 68%). Small N (90) limits strength but signal is consistent with US A021501 and Dutch PREOPANC data.

Source: PMID 36521500

Timeline

    Guideline citations

    • NCCN PANCREATIC (p.64)