A long-term analysis of the ESPAC4 trial shows that combining gemcitabine with capecitabine (GemCap) after surgery improves survival for patients with pancreatic cancer compared to gemcitabine alone.
After nearly nine years of follow-up, patients receiving GemCap lived a median of 31.6 months, compared with 28.4 months for those on gemcitabine. Five-year survival was 32% versus 25%. The benefit was strongest for patients with complete tumor removal and no lymph node involvement.
While mFOLFIRINOX is now the preferred treatment, not all patients are eligible due to age, fitness, or lab criteria. For those who cannot receive mFOLFIRINOX, GemCap offers a clear survival advantage. Side effects differ: GemCap more often causes hand-foot syndrome and low white blood cells, while mFOLFIRINOX more commonly causes fatigue, diarrhea, and nerve issues.
Researchers say GemCap remains a strong option for patients not suited for mFOLFIRINOX, especially those with clean surgical margins or no lymph node involvement.