In a German phase III trial (CONKO-007) reported in the Journal of Clinical Oncology,1Rainer Fietkau, MD, of the Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany, and colleagues found that adding chemoradiotherapy to chemotherapy vs chemotherapy alone after induction therapy did not improve the overall R0 resection rate in all patients with initially unresectable pancreatic tumors. However, chemoradiotherapy was associated with an R0 benefit among patients who did undergo surgery.
Rainer Fietkau, MD
In the open-label multicenter study, 495 patients with unresectable tumors enrolled between April 2013 and February 2021 were treated with induction chemotherapy consisting of FOLFIRINOX (fluorouracil, irinotecan, and oxaliplatin; n = 402) or gemcitabine (n = 93). A total of 336 patients without disease progression after 3 months of induction therapy were randomly assigned to receive the same chemotherapy (n = 167) or chemoradiotherapy with 50.4 Gy concurrently with gemcitabine (n = 169).
The overall R0 resection rate was 25% in the chemoradiotherapy group vs 18% in the chemotherapy group (P = .113). No difference was observed in the proportions of patients in each group who underwent surgery (P = .91). R0 resection was achieved in 69.4% in the chemoradiotherapy group who underwent surgery vs 50.0% in the chemotherapy group who underwent surgery (P = .04). The ratio of R0/R1/R2/no resection favored chemoradiotherapy (P = .02).
Among all patients, no difference in overall survival was observed between the chemoradiotherapy group vs the chemotherapy group (hazard ratio [HR] = 0.937, 95% confidence interval [CI] = 0.747–1.174, P = .57). Overall, surgery was associated with improved overall survival (HR = 0.525, 95% CI = 0.408–0.676, P < .001).
DISCLOSURE: The study was supported by German Cancer Aid. For full disclosures of the study authors, visit ascopubs.org.
REFERENCE
1. Fietkau R, et al: J Clin Oncol. August 13, 2025 (early release online).
