A trial looking at chemotherapy after surgery for pancreatic cancer (ESPAC 3 v2)

Cancer type:

Pancreatic cancer




Phase 3

This trial was comparing the chemotherapy drugs fluorouracil and gemcitabine after surgery for pancreatic cancer. This trial was supported by Cancer Research UK.

Many pancreatic cancers start in the cells lining the ducts inside the pancreas and are known as ductal cancers. But a small number start in a part of the pancreas called the ampulla of Vater.  As this is quite rare, there is not a standard treatment Open a glossary item for this type of pancreatic cancer.

Doctors can sometimes treat pancreatic cancer with surgery. But even if the cancer is removed, there is a chance that it could come back. Having chemotherapy after surgery may stop this happening.  Gemcitabine is the chemotherapy drug that is most often used to treat ductal pancreatic cancer. In this trial, researchers compared it with another drug called fluorouracil.

The aim of this trial was to see which drug helped people with ductal pancreatic cancer to live longer after surgery.

The trial also looked at whether either type of chemotherapy helped people with pancreatic cancer that started in the ampulla of Vater.

Summary of results

The researchers found that people with ductal cancer lived for about the same length of time whether they had fluorouracil or gemcitabine.

The trial recruited 1,088 people with ductal cancer in a number of different countries.  Everybody taking part had surgery to remove pancreatic cancer, followed by up to 6 months of chemotherapy.

  • 551 people had fluorouracil and a vitamin called folinic acid Open a glossary item
  • 537 people had gemcitabine

The average length of time people lived after surgery was just under 2 years in both groups.

The side effects were different between the groups.

The researchers asked more than 500 of the people taking part to complete questionnaires about their side effects and how they had been feeling. This is called a quality of life study. People in both groups rated their quality of life about the same.

The trial also recruited 304 people who had pancreatic cancer that started in the ampulla of vater. After having surgery to remove their cancer, they were put into 1 of 3 groups.

  • 101 had fluorouracil
  • 98 had gemcitabine
  • 105 had no chemotherapy

The trial team presented these results at a conference in 2011. They found that although a higher percentage of people who had chemotherapy were alive 5 years after treatment, the difference was quite small and may have happened by chance.  But they suggest that as there was some benefit for people having one chemotherapy drug, more trials could look at having a combination of chemotherapy drugs for this type of pancreatic cancer.

Another trial called ESPAC-4 is looking at gemcitabine alongside a tablet form of fluorouracil called capecitabine.  The aim is to see if this combination of the 2 drugs helps people more than gemcitabine alone after surgery for pancreatic cancer.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Neoptolemos

Supported by

Cancer Research UK
National Institute for Health Research Cancer Research Network (NCRN)

Other information

This is Cancer Research UK trial number CRUK/00/006.

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Freephone 0808 800 4040

Last review date

CRUK internal database number:

Oracle 104

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

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