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ESMO 2025 | CASSANDRA: short- versus long-course preoperative chemotherapy in PDAC
Michele Reni, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy, discusses the Phase III CASSANDRA trial (NCT04793932) of short- versus long-course preoperative chemotherapy in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC). While event-free and overall survival were similar between arms, extended preoperative treatment significantly improved pathologic complete response and nodal negativity rates, suggesting potential benefit from longer chemotherapy duration before surgery in this population. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
CASSANDRA was a phase three trial based on a double randomization. The first randomization was presented earlier this year at the ASCO meeting. The second part, that is the object of today, was a short versus long preoperative chemotherapy. Patients who were progression-free and without limiting toxicity after four months of chemotherapy were randomized for the second time to receive two further months of pre-operative chemotherapy versus surgery, immediate surgery, and completing the chemotherapy after surgery...
CASSANDRA was a phase three trial based on a double randomization. The first randomization was presented earlier this year at the ASCO meeting. The second part, that is the object of today, was a short versus long preoperative chemotherapy. Patients who were progression-free and without limiting toxicity after four months of chemotherapy were randomized for the second time to receive two further months of pre-operative chemotherapy versus surgery, immediate surgery, and completing the chemotherapy after surgery. So, long versus short pre-operative chemo. So, what we did was that there was no difference in terms of event-free survival between the two arms. So, there is no difference in the primary endpoint that was event-free survival. We observed a difference in terms of secondary endpoints because the longer chemotherapy was able to achieve a significantly higher pathological complete response rate and R0 resection rate and CA 125 response rate. Furthermore, there was a higher number of cycles that were delivered in patients with longer chemotherapy and also a better dose intensity.
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