Michele Reni, MD, is a Specialist in Medical Oncology at the Department of Medical Oncology at the San Raffaele Research Hospital in Milan.

Michele Reni, MD, is a Specialist in Medical Oncology at the Department of Medical Oncology at the San Raffaele Research Hospital in Milan

"What we observed is that the PAXG regimen significantly prolonged EFS, both from a statistical and clinical perspective. In particular, the median EFS was prolonged…from 10.2 to 16.0 months, and the 3-year EFS [rate] was more than doubled, from 13% to 31% in the mFOLFIRINOX and PAXG arms, respectively."

Michele Reni, MD, a specialist in medical oncology in the Department of Medical Oncology at San Raffaele Scientific Institute, discussed findings from the phase 3 CASSANDRA trial (NCT04793932) evaluating the efficacy of preoperative PAXG (capecitabine, cisplatin, nab-paclitaxel [Abraxane], and gemcitabine) compared with mFOLFIRINOX (oxaliplatin, leucovorin, irinotecan, and fluorouracil) in patients with resectable or borderline resectable stage I to III pancreatic ductal adenocarcinoma.

 demonstrated that At a median follow-up of 24.5 months in the PAXG arm and 26.0 months in the mFOLFIRINOX arm, the median event-free survival (EFS) was 16.0 months (95% CI, 12.4-19.8) with PAXG vs 10.2 months (95% CI, 8.7-13.0) with mFOLFIRINOX (HR, 0.64; 95% CI, 0.48-0.86; 

 = .003). The respective 1-year EFS rates were 61% (95% CI, 56%-65%) vs 45% (95% CI, 41%-49%), and the 3-year EFS rates were 31% (95% CI, 25%-36%) vs 13% (95% CI, 9%-17%) in the respective arms.

According to Reni, these findings support the clinical relevance of the PAXG regimen in the neoadjuvant setting, particularly given the observed 6-month increase in median EFS and the more than twofold increase in 3-year EFS. He emphasized that the improvement in multiple clinical endpoints suggests a potential benefit in overall treatment durability and long-term disease control.

Ultimately, Reni stated that PAXG may represent the most suitable neoadjuvant option for patients with resectable or borderline resectable stage I to III pancreatic ductal adenocarcinoma. Further investigation may help confirm these findings and support broader incorporation of PAXG into standard treatment strategies for early-stage disease.

Videos

Michele Reni, MD, discusses the efficacy of pre-operative PAXG compared with modified FOLFIRINOX in stage I to III PDAC.

Michele Reni, MD

Articles

Dr Reni on the Efficacy of Preoperative PAXG in Stage I to III PDAC