The authors of the PACT-21 CASSANDRA trial have responded to critiques published in The Lancet, defending their phase 3 study on pancreatic ductal adenocarcinoma (PDAC). They acknowledge that the scarcity of such trials simplifies drawing evidence-based conclusions.
The correspondence addresses two sets of comments, one from John P Neoptolemos and colleagues and another from Christos Fountzilas and colleagues. The authors concede that standards for adjuvant therapy in resected patients are solidly established.
However, they argue these standards hold negligible relevance for patients with a worse prognosis who are candidates for neoadjuvant therapy. The exchange highlights a gap in clinical guidance for this population.
This debate underscores the ongoing struggle to improve outcomes in PDAC, one of the deadliest cancers. The differing viewpoints reflect the challenge of applying trial results across distinct clinical scenarios.
The authors' reply was published in The Lancet, part of the ongoing academic discourse surrounding the trial's methodology and implications.