Resected pancreatic cancer: the advantage of mFOLFIRINOX over gemcitabine was seen only in KRAS-mutated tumours — molecular analysis of PRODIGE-24

A molecular analysis of the randomised PRODIGE-24/CCTG PA6 trial sequenced 317 of 350 resected pancreatic adenocarcinomas (168 patients treated with mFOLFIRINOX, 149 with gemcitabine). The advantage of mFOLFIRINOX over gemcitabine in disease-free survival was confined to KRAS-mutated tumours (sHR 0.60; 95% CI 0.45-0.79; p<0.001), with no benefit demonstrated in KRAS wild-type tumours. In the mFOLFIRINOX arm the classical PurIST subtype was associated with longer disease-free survival than the basal-like subtype (sHR 0.48; 95% CI 0.31-0.77), while neither homologous recombination repair gene status nor BRCA status was predictive (interaction p = 0.568 and 0.785). The authors stress that the findings do NOT justify changing current practice: mFOLFIRINOX remains the adjuvant standard, and the absence of benefit in KRAS wild-type tumours requires further study.