Add onc brain to your Home Screen: tap Share, then Add to Home Screen.
GI Upper
2026-06-10
NRG Oncology/RTOG 0848 NCT01013649
ForResected pancreatic head adenocarcinoma, post adjuvant gemcitabine
TL;DROS HR 0.96 (90% CI 0.79-1.18), p=0.77; adding adjuvant chemoradiation to gemcitabine did not improve survival after resected pancreatic head adenoca.
vs leading data
- vs PRODIGE-24 (2018): gemcitabine backbone here predates the modern adjuvant FOLFIRINOX standard, limiting applicability
10 details 1 trial watching
Methods
- 🔍 Phase III, 2-step design; Step 2 randomized 354 pts after curative pancreatic-head resection (median age 63, 56% PS 1)
- 💊 Backbone both arms: adjuvant gemcitabine (Step 1 tested gem vs gem+erlotinib)
- 🔍 Experimental arm added a 6th cycle plus fluoropyrimidine-sensitized chemoradiation (CXRT)
CONSORT flow
Randomized 354
↓
Chemo alone
allocated 174
Chemo + CXRT
allocated 180
Results
- 📊 1° EP OS not met: HR 0.96 (90% CI 0.79-1.18), 1-sided p=0.38, 2-sided p=0.77
- 📊 Univariate OS by arm (no significant difference)
Endpoint Chemo alone (n=174) Chemo+CXRT (n=180) Median OS 2.6 yr (90% CI 2.1-3.1) 2.3 yr (90% CI 2.0-2.6) 5-yr OS 23.1% (17.7-28.6) 27.9% (22.2-33.6) - 📊 DFS trend favored CXRT: HR 0.82 (95% CI 0.65-1.03), p=0.089
- 📊 Node-negative subgroup: significant treatment-by-nodal interaction for OS (p=0.0063) and DFS (p=0.014) favoring CXRT
Critique
- ⚠️ Grade 3 toxicity higher with CXRT: 38% vs 19% (p<0.001)
- ⚠️ No increase in grade 4/5 toxicity with CXRT
- ⚠️ Node-negative signal is subgroup-interaction only; hypothesis-generating, not practice-defining
Open questions
- Does adjuvant CXRT benefit node-negative pts with modern FOLFIRINOX backbone?
- Neoadjuvant chemoradiation role for node-negative resectable pancreatic cancer n=125 · primary completion 2027-06 · phase 2 neoadjuvant CRT arm in resectable/BR-PDAC
📚 Sources · 📄 1 paper
Adjuvant Chemotherapy +/- Chemoradiotherapy for Adenocarcinoma of The Pancreatic Head: Results of The Radiotherapy Randomization of NRG Oncology/RTOG 0848
2026-05-30
Neo-CRAG
ForLocally advanced gastric/GEJ adenocarcinoma (cT3N2+, T4), peri-op XELOX eligible
TL;DRAdding neoadj CRT to peri-op XELOX: mDFS 52.7 vs 24.4 mo, mOS 67.5 vs 37.6 mo in high-risk LAGC.
vs leading data
- LRR halved despite D2 resection: supports a genuine RT contribution beyond chemo-alone locoregional control
| Metric | CRT | CT |
|---|---|---|
| 3-yr DFS | 55.6% | 42.4% |
| Median DFS | 52.7 mo | 24.4 mo |
| HR (95% CI) | 0.750 (0.607-0.928) | — |
| p | 0.008 | — |
7 details
Methods
- 🔍 N=620, 13 Chinese centers, 2013-2022; cT3N2+ or T4 gastric/GEJ; 36.3% EGJ primary
- 🔍 CRT arm: 45 Gy/25 fractions concurrent after C1 chemo, with dose-reduced oxaliplatin (100 mg/m²) and capecitabine (825 mg/m²)
CONSORT flow
Randomized 620
↓
CRT (XELOX + RT)
allocated 310
CT (XELOX)
allocated 310
Results
- 📊 mOS 67.5 vs 37.6 months, HR 0.781 (0.628-0.970), p=0.025
- 📊 Locoregional recurrence in R0-resected pts: 9.4% CRT vs 18.3% CT
- 📊 Pathologic response (CRT vs CT)
- pCR: 14.8% vs 6.2%
- ypN0: 56.1% vs 36.4%
- Tumor downstaging (ypT0-2): 42.6% vs 23.6%
Critique
- ⚠️ G3+ toxicity (CRT vs CT)
- Hematologic: 14.6% vs 10.3%
- Postop complications: 9.0% vs 7.6%
- ⚠️ Backbone is XELOX, not FLOT; limits direct applicability to FLOT-era Western practice
Open questions
- Does adding RT to FLOT peri-op chemo confer similar DFS/OS benefit?
- Optimal RT dose-fractionation in FLOT-era perioperative settings
- Long-term LRR and OS durability beyond 5 years
📚 Sources · 🐦 1 tweet
Neo-CRAG: Ph3 RCT (n=620, gastric/GEJ) - adding neoadj chemoRT to peri-op XELOX improved OS (68 v 38 mo).
— Dr. Nina Niu Sanford (@NiuSanford) May 30, 2026
Limitation=non-FLOT, BUT still relevant IMO b/c:
1) DFS/OS benefit substantial.
2) Improvements in pCR, downstg, LRR supports plausible RT effect on OS. #ASCO26 @OncoAlert pic.twitter.com/eeM0Z8p20M