Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2× 2 factorial phase 3 trial

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Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2× 2 factorial phase 3 trial

25 February 2026

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Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2× 2 factorial phase 3 trial

25022026

Reni M, Macchini M, Orsi G, Procaccio L, Malleo G, Carconi C et al.

Lancet 2025; 406: 2945-2956.

Some 132 patients were included, and the PAXG group had prolonged median even-free survival (16.0 vs. 10.2 months, P=0.0018), with similar rates of adverse events.

Comment: PAXG emerges as a compelling neoadjuvant alternative to mFOLFIRINOX in resectable and borderline resectable PDAC.

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Published on: 25 February 2026

Article ID: BJS-2026-0039

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Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2× 2 factorial phase 3 trial

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Preoperative mFOLFIRINOX versus PAXG for stage I–III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2× 2 factorial phase 3 trial

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