A 65-year-old man has resectable pancreatic head adenocarcinoma. Post-Whipple resection, the specimen shows R0 margins. He receives adjuvant chemotherapy. According to the ESPAC-4 trial, which regimen improved overall survival compared to gemcitabine alone?
- A Gemcitabine plus erlotinib
- B FOLFIRINOX
- C Gemcitabine plus capecitabine ✓
- D Gemcitabine plus nab-paclitaxel
Correct answer: C. Gemcitabine plus capecitabine
Explanation
The ESPAC-4 trial demonstrated that adjuvant gemcitabine plus capecitabine improved median overall survival to 28 months compared to 25.5 months with gemcitabine alone, establishing gemcitabine–capecitabine as a standard adjuvant regimen for resected pancreatic cancer. Modified FOLFIRINOX was validated in the PRODIGE 24/CCTG PA.6 trial (median OS 54 months vs 35 months) but this was a separate study.
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.