[Comment] Neoadjuvant quadruplet chemotherapy PAXG for pancreatic cancer

00:00 - 20 Nov 2025

Perioperative management of localised pancreatic ductal adenocarcinoma (PDAC) is informed by resectability criteria, which consider anatomy together with biological and clinical factors.1 In patients with resectable PDAC, adjuvant mFOLFIRINOX (modified 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) is a standard of care;2,3 however, many are unable to receive this regimen due to inadequate performance status after surgery. Trials have evaluated various neoadjuvant chemotherapy regimens; notably, two randomised controlled trials did not confirm superiority of mFOLFIRINOX or FOLFIRINOX over gemcitabine–nab-paclitaxel (SWOG 1505)4 and gemcitabine with radiation (PREOPANC-2).