Gene test could tailor chemo for tough pancreatic cancers

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Borderline-resectable pancreatic ductal adenocarcinoma (BR-PDAC) as defined by the National Comprehensive Cancer Network (NCCN) v2.2025 criteria, identified on contrast-enhanced CT scan and reviewed by a local multidisciplinary pancreatic expert board including at least a medical oncologist / onco-gastroenterologist, a pancreatic surgeon, and an expert pancreatic radiologist. No central review required. * WHO Performance Status 0-1. * Histologically confirmed pancreatic ductal adenocarcinoma, including histological variants. * Patient included-but not randomized-in the PRODIGE 104 A NEOPREDICT study due to a negative gemcitabine sensitivity signature (GEM-). * Negative gemcitabine transcriptomic signature (test centrally performed in PRODIGE 104 A NEOPREDICT). * No prior chemotherapy or radiotherapy for pancreatic cancer, and no previous definitive pancreatic cancer resection (except one cycle of mFOLFIRINOX administered while awaiting the signature result). * Age \> 18 years and \< 80 years, with the possibility to include patients aged 75-80 if a standardized geriatric assessment confirms eligibility for the study chemotherapy regimen. * Ability and willingness to comply with protocol requirements during the entire study period (treatment, scheduled visits, clinical and biological examinations, follow-up). * Patient's non-opposition to participation in the study. * Affiliation to the French national health insurance system. Exclusion Criteria: * Strictly resectable or locally advanced PDAC according to NCCN criteria. * Distant metastases, including inter-aortocaval lymph nodes. * Any condition contraindicating the use of irinotecan, oxaliplatin, or 5-FU. * Complete dihydropyrimidine dehydrogenase (DPD) deficiency. * Any uncontrolled or unstable medical condition within the past 6 months (e.g., hepatic, renal, respiratory, or cardiac insufficiency). * Another concomitant malignancy or history of cancer within the past 3 years, except for adequately treated carcinoma in situ of the cervix or basal/squamous cell skin carcinoma. * Pregnancy or breastfeeding. * Patients under legal protection, guardianship, curatorship, or under judicial/administrative protection. * Patients receiving psychiatric care or unable to provide consent. * Inability to comply with medical follow-up for geographical, social, or psychological reasons.