The ESPAC-4 trial in pancreatic cancer demonstrated which of the following regarding adjuvant therapy after pancreaticoduodenectomy (Whipple's procedure)?

• A Gemcitabine alone is equivalent to gemcitabine plus capecitabine in terms of overall survival
• B Adjuvant chemoradiotherapy is superior to chemotherapy alone for all resected pancreatic cancers
• C Adjuvant FOLFIRINOX is the standard of care for all resected pancreatic ductal adenocarcinoma
• D Combination gemcitabine plus capecitabine significantly improved median overall survival compared to gemcitabine alone ✓

Explanation

The ESPAC-4 trial (European Study Group for Pancreatic Cancer-4) demonstrated that combination adjuvant gemcitabine plus capecitabine significantly improved median overall survival (28 months vs. 25.5 months) compared to gemcitabine alone after resection of pancreatic ductal adenocarcinoma, establishing combination chemotherapy as the new standard. The PRODIGE-24/CCTG PA.6 trial subsequently showed modified FOLFIRINOX superior to gemcitabine in fit patients, but ESPAC-4 specifically addressed the gem vs gem+cap question.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.