LAUSR

To the Editor: C onroy et al 1 report that modified FOLFIRINOX (the combination chemotherapy regimen with oxaliplatin, irinotecan, fluorouracil, and leucovorin) achieved a significant median disease-free survival (mDFS) of 21.6 months after a follow-up of almost 3 years comparedwith 12.8months of gemcitabine group (P < 0.001) in resected patients with pancreatic ductal adenocarcinoma (PDAC). The trial is well balanced with wellselected inclusion criteria (absence of metastatic disease, Eastern Cooperative Oncology Group performance-status score of 0–1) and with the exclusion of patients with non-ductal pancreatic tumors, incomplete resection, and with serum carbohydrate (CA) 19-9 level of more than 180 U/mL. On the contrary, in ESPAC-4, the trial evaluating the combination of gemcitabine and capecitabine in resected PDAC, it was unclear what the overall patient population of the study was. In fact, a maximum limit of CA 19-9 was not considered as an inclusion criterion for patients with baseline value of over 8000 U/mL; a postoperative restaging was not required, so metastatic disease patients could not be excluded. On the whole, the most interesting result regards survival. The median overall survival (mOS) was 54.4 and 35 months in the