Pancreatic Carcinoma: Chemoradiation Compared With Chemotherapy Alone After Induction Chemotherapy (CONKO-007)

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ClinicalTrials.gov Identifier: NCT01827553

Recruitment Status : Recruiting

First Posted : April 9, 2013

Last Update Posted : October 9, 2020

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Sponsor:

Information provided by (Responsible Party):

University of Erlangen-Nürnberg Medical School

Study Description

Brief Summary:

This randomized trial examines the effectiveness of chemoradiotherapy compared to chemotherapy alone after induction chemotherapy with 3 cycles of gemcitabine or 6 cycles of FOLFIRINOX in patients with locally advanced, non resectable and non-metastatic pancreatic cancer. Chemotherapeutic agent in chemoradiotherapy is gemcitabine administered in 5 cycles, the agent and its administration for sole chemotherapy is determined by induction chemotherapy. Operability of tumor is evaluated at week 11 after randomisation. Patients will be followed for the duration of therapy and for 5 years after the last study treatment. Overall survival at the end of follow up is defined as primary endpoint. Secondary endpoints are tumor-free survival, rate of local recurrence or local progression, rate of distant metastasis, acute and late toxicity of the chemoradiotherapy, quality of life, rate of remission, rate of curative resections (R0) after chemotherapy and chemoradiotherapy. It is planned to include a total number of 830 patients.

Condition or disease	Intervention/treatment	Phase
Pancreatic Cancer	Drug: Induction chemotherapy with gemcitabine or FOLFIRINOX Radiation: Radiotherapy, 28 x 1.8 Gy Drug: Chemotherapy, gemcitabine Drug: Chemotherapy with gemcitabine or FOLFIRINOX according to induction chemotherapy	Phase 3

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	830 participants
Allocation:	Randomized
Intervention Model:	Factorial Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Significance of Chemoradiation Following Induction Chemotherapy in Locally Advanced,Unresectable Pancreatic Cancer -a Randomised Phase 3 Trial: Chemoradiation Following Induction Chemotherapy Compared With Chemotherapy Alone
Study Start Date :	March 2013
Estimated Primary Completion Date :	April 2022
Estimated Study Completion Date :	April 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Pancreatic Cancer

Drug Information available for: Gemcitabine Gemcitabine hydrochloride

Genetic and Rare Diseases Information Center resources: Pancreatic Cancer

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Induction CT, chemoradiotherapy Induction chemotherapy with gemcitabine or FOLFIRINOX; Radiotherapy, 28 x 1.8 Gy; Chemotherapy, gemcitabine;	Drug: Induction chemotherapy with gemcitabine or FOLFIRINOX According to medical recommendation, induction chemotherapy is performed with gemcitabine (3 cycles a 3 administrations, 1000 mg/m^2/d)or FOLFIRINOX (6 cycles; 1 cycle: oxaliplatin 85 mg/m^2 2 h infusion, folinic acid 400 mg/ m^2 2h infusion completed after 30 min with irinotecan infusion 180 mg/m^2 for 90 minutes, bolus application 5-FU 400 mg/m^2 followed by 46h infusion of 5-FU 2400 mg/m^2) Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed Radiation: Radiotherapy, 28 x 1.8 Gy Radiotherapy combined with chemotherapy starts on day 1 of chemotherapy. Radiation volume is restricted to macroscopic visual tumor region. Radiation is performed in 28 fractions with 1.8 Gy resulting in a total dose of 50.4 Gy. Drug: Chemotherapy, gemcitabine 5 cycles of 300 mg/m^2/d gemcitabine infusions and than 3 administrations of 1000 mg/m^2/d Other Name: all brands of gemcitabine are allowed
Active Comparator: Induction CT, chemotherapy Induction chemotherapy with gemcitabine or FOLFIRINOX; Chemotherapy with gemcitabine or FOLFIRINOX according to induction chemotherapy	Drug: Induction chemotherapy with gemcitabine or FOLFIRINOX According to medical recommendation, induction chemotherapy is performed with gemcitabine (3 cycles a 3 administrations, 1000 mg/m^2/d)or FOLFIRINOX (6 cycles; 1 cycle: oxaliplatin 85 mg/m^2 2 h infusion, folinic acid 400 mg/ m^2 2h infusion completed after 30 min with irinotecan infusion 180 mg/m^2 for 90 minutes, bolus application 5-FU 400 mg/m^2 followed by 46h infusion of 5-FU 2400 mg/m^2) Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed Drug: Chemotherapy with gemcitabine or FOLFIRINOX according to induction chemotherapy Chemotherapeutic administration started with during induction chemotherapy is continued; Gemcitabine: 3 cycles a 3 administrations of 1000 mg/m^2/d gemcitabine infusions FOLFIRINOX: 6 cycles Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed

Arm

Intervention/treatment

Experimental: Induction CT, chemoradiotherapy

Induction chemotherapy with gemcitabine or FOLFIRINOX; Radiotherapy, 28 x 1.8 Gy; Chemotherapy, gemcitabine;

Drug: Induction chemotherapy with gemcitabine or FOLFIRINOX

According to medical recommendation, induction chemotherapy is performed with gemcitabine (3 cycles a 3 administrations, 1000 mg/m^2/d)or FOLFIRINOX (6 cycles; 1 cycle: oxaliplatin 85 mg/m^2 2 h infusion, folinic acid 400 mg/ m^2 2h infusion completed after 30 min with irinotecan infusion 180 mg/m^2 for 90 minutes, bolus application 5-FU 400 mg/m^2 followed by 46h infusion of 5-FU 2400 mg/m^2)

Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed

Radiation: Radiotherapy, 28 x 1.8 Gy

Radiotherapy combined with chemotherapy starts on day 1 of chemotherapy. Radiation volume is restricted to macroscopic visual tumor region. Radiation is performed in 28 fractions with 1.8 Gy resulting in a total dose of 50.4 Gy.

Drug: Chemotherapy, gemcitabine

5 cycles of 300 mg/m^2/d gemcitabine infusions and than 3 administrations of 1000 mg/m^2/d

Other Name: all brands of gemcitabine are allowed

Active Comparator: Induction CT, chemotherapy

Induction chemotherapy with gemcitabine or FOLFIRINOX; Chemotherapy with gemcitabine or FOLFIRINOX according to induction chemotherapy

Drug: Induction chemotherapy with gemcitabine or FOLFIRINOX

Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed

Drug: Chemotherapy with gemcitabine or FOLFIRINOX according to induction chemotherapy

Chemotherapeutic administration started with during induction chemotherapy is continued; Gemcitabine: 3 cycles a 3 administrations of 1000 mg/m^2/d gemcitabine infusions FOLFIRINOX: 6 cycles

Other Name: all brands of gemcitabine and FOLFIRINOX components are allowed

Outcome Measures

Primary Outcome Measures :

Overall survival [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]

Secondary Outcome Measures :

Tumor-free survival [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
rate of local recurrence or local progression [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
Rate of distant metastasis [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
Acute and late toxicity of the chemoradiotherapy [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
Rate of remission [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
Rate of curative resections (R0) after chemotherapy and chemoradiotherapy [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]
Changes in Quality of life [ Time Frame: Participants will be followed for the duration of therapy and for 5 years after the last study treatment ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age > 18 years
histologically confirmed adenocarcinoma of the pancreas
no evidence of distant metastasis based on computed tomography of the thorax and abdomen
non resectable pancreatic cancer
no evidence of peritoneal carcinosis
ECOG-performance status ≤ 2
signed study-specific consent form prior to therapy

Exclusion Criteria:

fertile patients who refuse effective contraception during study treatment
synchron second malignant neoplasm except basal cell carcinoma of the skin and carcinoma in situ of the cervix after curative therapy
the Inclusion of patients with prior or concurrent malignancy (≤ 5 years prior to enrolment in study) must be discussed
chronic inflammatory disease of the intestine
known allergic reactions on study medication
on-treatment participation on other trials
insufficient liver function: Bilirubin > 2,0 mg/dl; SGOT, SGPT, alkaline phosphatase, gGT more than 3 times upper limit of normal (after Stent implantation in case of obstructive jaundice); cirrhosis of the liver Child B and C
insufficient bone marrow function: WBC < 3,0 x 10^9/l, Platelets > 100 x 10^9/l
serum creatinine > 1,5 mg/dl, creatinin clearance < 60ml/min (or comparable test)
preexisting uncontrolled cardiac disease, signs of cardiac failure, or rhythm disturbances requiring therapy, myocardial infarction within the past 6 months, unstable angina pectoris, congestive heart failure, New York Heart Association (NYHA) class III or IV heart disease
neurological and/or psychiatric diseases: stroke, dementia, epilepsy, psychosis
active intractable or uncontrollable infection, HIV-infection
prior radiotherapy or chemotherapy

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01827553

Contacts

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Contact: Rainer Fietkau, MD	++49(0)9131 85 ext 33968	st-studiensekretariat@uk-erlangen.de
Contact: Sabine Semrau, MD	++49(0)9131 85 ext 33968	st-studiensekretariat@uk-erlangen.de

Locations

Show 54 study locations

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Germany
Aachen Universitätsklinikum	Recruiting
Aachen, Germany, 52074
Contact: Ulf Peter Neumann, MD chirurgie@ukaachen.de
Contact: Florian Ulmer, MD fulmer@ukaachen.de
Principal Investigator: Ulf Peter Neumann, MD
Sub-Investigator: Florian Ulmer, MD
Klinikum Augsburg	Terminated
Augsburg, Germany, 86156
Bayreuth, Klinikum	Recruiting
Bayreuth, Germany, 95445
Contact: Ludwig Keilholz, MD ludwig.keilholz@klinikum-bayreuth.de
Contact: Alexander Kiani, MD alexander.kiani@klinikum-bayreuth.de
Principal Investigator: Ludwig Keilholz, MD
Sub-Investigator: Alexander Kiani, MD
San Klinikum Berlin-Lichtenberg	Terminated
Berlin, Germany, 10365
Berlin Charité	Terminated
Berlin, Germany, 13353
Bochum, Augusta-Kranken-Anstalt, Hämatologie/Onkologie	Recruiting
Bochum, Germany, 44791
Contact: Dirk Behringer, MD behringer@augusta-bochum.de
Contact: Annette Nolte, MD nolte@augusta-bochum.de
Principal Investigator: Dirk Behringer, MD
Sub-Investigator: Annette Nolte, MD
Bochum, St. Josef-Hospital	Recruiting
Bochum, Germany, 44791
Contact: Waldemar Uhl, MD w.uhl@klinikum-bochum.de
Contact: Anke Reinacher-Schick, MD anke.reinacher@rub.de
Principal Investigator: Waldemar Uhl, MD
Sub-Investigator: Anke Reinacher-Schick, MD
Knappschaftskrankenhaus Bochum	Terminated
Bochum, Germany, 44892
Brandenburg Städtisches Klinikum	Recruiting
Brandenburg, Germany, 14770
Contact: René Mantke, MD mantke@klinikum-brandenburg.de
Contact: Peter M Deckert, MD deckert@klinikum-brandenburg.de
Principal Investigator: René Mantke, MD
Sub-Investigator: Peter Markus Deckert, MD
Bremen Klinikum Mitte	Recruiting
Bremen, Germany, 28177
Contact: Johann Ockenga, MD johann.ockenga@klinikum-bremen-mitte.de
Contact: Thomas Martin, MD thomas.martin@klinikum-bremen-mitte.de
Principal Investigator: Johann Ockenga, MD
Sub-Investigator: Thomas Martin, MD
Klinikum Coburg	Terminated
Coburg, Germany, 96450
Städtisches Klinikum Dessau	Terminated
Dessau, Germany, 06847
Dresden Onkologische Gemeinschaftspraxis	Recruiting
Dresden, Germany, 01307
Contact: Lutz Jacobasch, MD jacobasch@onkologie-dresden.net
Contact: Thomas Wolf, MD wolf@onkologie-dresden.net
Principal Investigator: Lutz Jacobasch, MD
Sub-Investigator: Thomas Wolf, MD
Erlangen Universitätsklinikum	Recruiting
Erlangen, Germany, 91054
Contact: Rainer Fietkau, MD ++49(0) 9131 85 ext 33968 st-studiensekretariat@uk-erlangen.de
Contact: Sabine Semrau, MD ++49(0) 9131 85 ext 33968 st-studiensekretariat@uk-erlangen.de
Principal Investigator: Rainer Fietkau, MD
Sub-Investigator: Sabine Semrau, MD
Esslingen Klinikum, Hämatologie/Onkologie	Terminated
Esslingen, Germany, 73730
Frankfurt/Main Universitätsklinikum	Recruiting
Frankfurt/Main, Germany, 60590
Contact: Claus M Rödel, MD claus.roedel@kgu.de
Contact: Detlef Imhoff, MD strahlentherapie@kgu.de
Principal Investigator: Claus M Rödel, MD
Sub-Investigator: Detlef Imhoff, MD
Frechen PIOH	Withdrawn
Frechen, Germany, 50226
Freiburg Universitätsklinikum	Recruiting
Freiburg, Germany, 79106
Contact: Uwe Wittel, MD uwe.wittel@uniklinik-freiburg.de
Contact: Stefan Fichtner-Feigl, MD stefan.fichtner@uniklinik-freiburg.de
Principal Investigator: Uwe Wittel, MD
Sub-Investigator: Stefan Fichtner-Feigl, MD
Friedrichshafen Onkologische Schwerpunktpraxis	Recruiting
Friedrichshafen, Germany, 88045
Contact: Helmut Oettle, MD helmut.oettle@charite.de
Contact: Frank Mayer, MD frank.mayer@med.uni-tuebingen.de
Principal Investigator: Helmut Oettle, MD
Sub-Investigator: Frank Mayer, MD
Onkologisches Zentrum Oberland, Klinikum Garmisch-Partenkirchen	Terminated
Garmisch-Partenkirchen, Germany, 82467
Göppingen Alb-Fils-Kliniken	Withdrawn
Göppingen, Germany, 73035
Göttingen Universitätsmedizin	Recruiting
Göttingen, Germany, 37075
Contact: Michael Ghadimi, MD michael.ghadimi@chirurgie-goettingen.de
Contact: Alexander König, MD alexander.koenig@med.uni-goettingen.de
Principal Investigator: Michael Ghadimi, MD
Sub-Investigator: Alexander König, MD
Halle St. Elisabeth und St. Barbara Krankenhaus	Recruiting
Halle/Saale, Germany, 06110
Contact: Bernhard Opitz, MD b.opitz@krankenhaus-halle-saale.de
Contact: Anett Krziwanie a.krziwanie@krankenhaus-halle-saale.de
Sub-Investigator: Bernhard Opitz, MD
Sub-Investigator: Anett Krziwanie, MD
Hamburg Hämatologisch-Onkologischer Schwerpunkt	Recruiting
Hamburg, Germany, 22457
Contact: Mathias Bertram, MD m.bertram@onkologie-partner.de
Contact: Sigrun Müller-Hagen, MD s.mueller-hagen@onkologie-partner.de
Principal Investigator: Mathias Bertram, MD
Sub-Investigator: Sigrun Müller-Hagen, MD
Heilbronn SLK-Kliniken	Recruiting
Heilbronn, Germany, 74078
Contact: Uwe Martens, MD uwe.martens@slk-kliniken.de
Contact: Markus Lindauer, MD markus.lindauer@slk-kliniken.de
Principal Investigator: Uwe Martens, MD
Sub-Investigator: Markus Lindauer, MD
St. Bernward Krankenhaus GmbH	Not yet recruiting
Hildesheim, Germany, 31134
Contact: Ulrich Kaiser, Prof. +49 5121 90 ext 1274 prof.dr.u.kaiser@bernward-khs.de
Contact: Thomas Heide, M.D. +49 512190 ext 1433 dr.t.heide@bernward-khs.de
Principal Investigator: Ulrich Kaiser, MD
Sub-Investigator: Thomas Heide, MD
Homburg Universitätsklinikum	Terminated
Homburg, Germany, 66421
Jena Universitätsklinikum	Recruiting
Jena, Germany, 07747
Contact: Udo Lindig, MD udo.lindig@med.uni-jena.de
Contact: Thomas Ernst, MD thomas.ernst@med.uni-jena.de
Principal Investigator: Udo Lindig, MD
Sub-Investigator: Thomas Ernst, MD
Köln Studiengesellschaft	Withdrawn
Köln, Germany, 50674
Köln Universitätsklinikum	Recruiting
Köln, Germany, 50937
Contact: Dirk Waldschmidt, MD dirk.waldschmidt@uk-koeln.de
Contact: Fabian Kütting, MD fabian.kuetting@uk-koeln.de
Principal Investigator: Dirk Waldschmidt, MD
Sub-Investigator: Fabian Kütting, MD
Köln Kliniken	Terminated
Köln, Germany, 51109
Landshut Klinikum	Withdrawn
Landshut, Germany, 84034
Leer MVM	Recruiting
Leer, Germany, 26789
Contact: Lothar Müller, MD lothar.mueller@onkologie-leer.de
Contact: Carsten Janßen, MD carsten.janssen@onkologie-leer.de
Principal Investigator: Lothar Müller, MD
Sub-Investigator: Carsten Janßen, MD
Leipzig UCCL	Recruiting
Leipzig, Germany, 04103
Contact: Florian Lordick, MD florian.lordick@medizin.uni-leipzig.de
Contact: Gertraud Stocker, MD gertraud.stocker@medizin.uni-leipzig.de
Principal Investigator: Florian Lordick, MD
Sub-Investigator: Gertraud Stocker, MD
Leverkusen Klinikum	Terminated
Leverkusen, Germany, 51375
Magdeburg Universitätsklinikum	Recruiting
Magdeburg, Germany, 39120
Contact: Roland Croner, MD roland.croner@med.ovgu.de
Contact: Marino Venerito, MD m.venerito@med.ovgu.de
Principal Investigator: Roland Croner, MD
Sub-Investigator: Marino Venerito, MD
Magdeburg Klinikum	Recruiting
Magdeburg, Germany, 39130
Contact: Karsten Ridwelski, MD karsten.ridwelski@klinikum-magdeburg.de
Contact: Christoph Kahl, MD christoph.kahl@klinikum-magdeburg.de
Principal Investigator: Karsten Ridwelski, MD
Sub-Investigator: Christoph Kahl, MD
Mainz Universitätsmedizin	Terminated
Mainz, Germany, 55131
Mannheim Universitätsmedizin	Recruiting
Mannheim, Germany, 68167
Contact: Nicolai Härtel, MD nicolai.haertel@umm.de
Contact: Nadine Schulte, MD nadine.schulte@umm.de
Principal Investigator: Nicolai Härtel, MD
Sub-Investigator: Nadine Schulte, MD
Marburg Universitätsklinikum	Terminated
Marburg, Germany, 35043
München Großhadern LMU	Recruiting
München, Germany, 81377
Contact: Volker Heinemann, MD volker.heinemann@med.uni-muenchen.de
Contact: Stefan Böck, MD sekrmed3@med.uni-muenchen.de
Principal Investigator: Volker Heinemann, MD
Sub-Investigator: Stefan Böck, MD
Münster Universitätsklinikum	Recruiting
Münster, Germany, 48149
Contact: Hans Th. Eich, MD Hans.Eich@ukmuenster.de
Contact: Benjamin Strücker, MD benjamin.struecker@ukmuenster.de
Principal Investigator: Hans Th. Eich, MD
Sub-Investigator: Benjamin Strücker, MD
Oldenburg Pius Hospital	Recruiting
Oldenburg, Germany, 26121
Contact: Frank Griesinger, MD frank.griesinger@pius-hospital.de
Contact: Hagen Flach, MD hagen.flach@pius-hospital.de
Principal Investigator: Frank Griesinger, MD
Sub-Investigator: Hagen Flach, MD
Ostfildern Paracelsus Krankenhaus Ruit	Terminated
Ostfildern, Germany, 73760
Regensburg Krankenhaus Barmherzige Brüder	Recruiting
Regensburg, Germany, 93049
Contact: Nicolas Moosmann, MD nicolas.moosmann@barmherzige-regensburg.de
Contact: Anke Schlenska-Lange, MD anke.schlenska-lange@barmherzige-regensburg.de
Principal Investigator: Nicolas Moosmann, MD
Sub-Investigator: Anke Schlenska-Lange, MD
Regensburg Universitätsklinikum	Recruiting
Regensburg, Germany, 93053
Contact: Matthias Hautmann, MD matthias.hautmann@klinik.uni-regensburg.de
Contact: Oliver Koelbl, MD oliver.koelbl@ukr.de
Principal Investigator: Matthias Hautmann, MD
Sub-Investigator: Oliver Koelbl, MD
Stuttgart Klinikum SCC	Terminated
Stuttgart, Germany, 70174
Stuttgart Marienhospital	Terminated
Stuttgart, Germany, 70199
Traunstein Klinikum	Recruiting
Traunstein, Germany, 83278
Contact: Thomas W. Kubin, MD thomas.kubin@klinikum-traunstein.de
Contact: Elke Hagenreiner, MD elke.hagenreiner@klinikum-traunstein.de
Principal Investigator: Thomas W. Kubin, MD
Sub-Investigator: Elke Hagenreiner, MD
Trier Mutterhaus der Borromäerinnen	Withdrawn
Trier, Germany, 54290
Trier Krankenhaus der Barmherzigen Brüder	Terminated
Trier, Germany, 54292
Tübingen Universitätsklinikum	Terminated
Tübingen, Germany, 72076
Ulm Universitätsklinikum	Terminated
Ulm, Germany, 89081
Würzburg CCC Mainfranken	Recruiting
Würzburg, Germany, 97080
Contact: Volker Kunzmann, MD kunzmann_v@klinik.uni-wuerzburg.de
Contact: Bülent Polat, MD polat_b@ukw.de
Principal Investigator: Volker Kunzmann, MD
Sub-Investigator: Bülent Polat, MD

Sponsors and Collaborators

University of Erlangen-Nürnberg Medical School

Investigators

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Principal Investigator:	Rainer Fietkau, MD	Strahlenklinik, Universitätsklinikum Erlangen

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Wittel UA, Lubgan D, Ghadimi M, Belyaev O, Uhl W, Bechstein WO, Grützmann R, Hohenberger WM, Schmid A, Jacobasch L, Croner RS, Reinacher-Schick A, Hopt UT, Pirkl A, Oettle H, Fietkau R, Golcher H. Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma - results of the Conko-007 multicenter trial. BMC Cancer. 2019 Oct 22;19(1):979. doi: 10.1186/s12885-019-6148-5.

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Responsible Party:	University of Erlangen-Nürnberg Medical School
ClinicalTrials.gov Identifier:	NCT01827553
Other Study ID Numbers:	2009-014476-21
First Posted:	April 9, 2013 Key Record Dates
Last Update Posted:	October 9, 2020
Last Verified:	October 2020

Keywords provided by University of Erlangen-Nürnberg Medical School:


pancreatic cancer chemoradiotherapy chemotherapy FOLFIRINOX gemcitabine

Additional relevant MeSH terms:

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Pancreatic Neoplasms Digestive System Neoplasms Neoplasms by Site Neoplasms Endocrine Gland Neoplasms Digestive System Diseases Pancreatic Diseases Endocrine System Diseases Gemcitabine Folfirinox	Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Antiviral Agents Anti-Infective Agents Enzyme Inhibitors Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs

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