Zachary Bessette

GI Oncology Now

Results of <a href="https://www.gioncologynow.com/post/cassandra-neoadjuvant-paxg-versus-mfolfirinox-for-resectable-borderline-resectable-pdac" target="_blank" rel="noopener">CASSANDRA</a>&mdash;a randomized phase III trial of preoperative chemotherapy with mFOLFIRINOX or PAXG for stage I-III resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC)&mdash;may alter the standard of care for patients in this population.<a href="https://meetings.asco.org/abstracts-presentations/243684" target="_blank" rel="noopener">Results of this study</a> are presented at the 2025 American Society of Clinical Oncology Annual Meeting.CASSANDRA randomized patients (n=260) aged 75 years or less, stratified by site and CA19.9, to receive either PAXG (oral daily capecitabine 1250 mg/m2&nbsp;with biweekly cisplatin 30 mg/m2, nab-paclitaxel 150 mg/m2, gemcitabine 800 mg/m2; arm A) or mFOLFIRINOX (biweekly 5-fluorouracil 2400 mg/m2, irinotecan 150 mg/m2, oxaliplatin 85 mg/m2; arm B) for either 6 months before or 4 months before and 2 months after surgery.The primary endpoint of the study was event-free survival (EFS), measured by the absence of progression, recurrence, two consecutive increases in CA19.9 of at least 20% separated by at least 4 weeks, unresectability, intraoperative metastasis, or death. Among the secondary endpoints were overall survival (OS); radiological, CA19.9, and pathological response rate; resection rate, toxicity, and quality of life.A total of 132 patients and 128 patients were randomized to arm A and arm B, respectively, between November 2020 and April 2024.At data cutoff on March 1, 2025, after a median follow-up of 23.9 months, 3-year EFS was 30% and 14%, respectively (HR, 0.66; 95% CI, 0.49-0.89; P=0.005). Additionally, researchers reported that disease control rate was 98% versus 91%, CA19.9 reduction of greater than 50% was 88% versus 64%, resection rate was 75% versus 67%, and pathologic stage less than 2 was 35% versus 23%.Additionally, they provided grade 3/4 toxicity updates: neutropenia (44% vs 30%), fatigue (8% vs 8%), diarrhea (2% vs 5%), nausea/vomiting (7% vs 10%), neuropathy (7% versus 4%) and infections (6% vs 9%).&ldquo;Neoadjuvant PAXG significantly improved EFS compared to mFOLFIRINOX in patients with resectable/borderline resectable PDAC,&rdquo; they concluded.

Ronan Kelly, MD

CheckMate 577: Adjuvant Nivolumab Plus Neoadjuvant Chemoradiotherapy for Esophageal and Gastroesophageal Cancer

Esophageal Cancer

Richard Kim, MD

HERIZON-BTC-01 vs a Real-World Control Arm: Comparing Zanidatamab With Chemotherapy for Biliary Tract Cancer

Bile Duct Cancer

Richard S. Finn, MD

LEAP-002 Long-Term Follow-Up: Further Exploring Lenvatinib Plus Pembrolizumab for Liver Cancer

Liver Cancer

Latest News

CASSANDRA Study May Set New Standard for Neoadjuvant Chemo for Resectable, Borderline Resectable PDAC

Pancreatic Cancer

Results of CASSANDRA may alter the standard of care for patients with resectable PDAC.