OSPREY Registry: First Interim Analysis of Patients with Unresectable Locally Advanced Pancreatic Cancer Treated with EUS-Guided Phosphorus-32 Microparticles plus Gemcitabine-Based Chemotherapy in Routine Clinical Practice

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Aims To present, on behalf of the OSPREY Registry Investigators, the first interim analysis of outcomes for patients with unresectable locally advanced pancreatic cancer (uLAPC) treated with EUS-guided Phosphorus-32 ( 32 P) microparticle implantation plus chemotherapy and enrolled in the OSPREY registry. Methods OSPREY is a post-market, multi-centre, observational, prospective registry in which data is recorded from patients with uLAPC receiving gemcitabine-based chemotherapy who had EUS-guided implantation of 32 P microparticles (OncoSil Medical) device as part of their routine clinical care. Enrolment commenced April 2022 and is ongoing. Registry objectives include safety/tolerability (Adverse Device Effects [ADEs] possibly or probably related to 32 P device and/or implantation) and efficacy outcomes. Results At 1 August 2025, 64 patients (median age 66.5 years; 50% female) had enrolled in the registry from 19 centres in Austria (3 patients [4.7%]), Italy (12 [18.8%]), Greece (12 [18.8%]) and Spain (37 [57.8%]). 48 (75%) patients had 32 P microparticles implanted during 1 st -line chemotherapy, 25 (39.1%) at≤4 months from chemotherapy start and 22 (34.4%) at 4–12 months of chemotherapy start; 14 (21.9%) patients were implanted during 2 nd -line chemotherapy, primarily (17.2%) at≤4 months of commencing 2 nd -line chemotherapy. In total, 15.6% of patients reported ADEs. All ADEs were considered mild; 9 (14.1%) patients reported Grade 1 abdominal pain and 1 (1.6%) reported Grade 2 asthenia/fatigue, also possibly related to chemotherapy. All ADEs were anticipated, transient, managed conservatively and resolved without clinical sequelae. There were no Grade > 3 or serious ADEs (SADEs), no acute complications, no pancreatitis and no patient required hospital admission. The Local Disease Control Rate at 12 weeks post-implant (alive; no tumour progression) was 91.4% in 1 st -line chemotherapy patients and 77.8% at 2 nd -line. To date, 7 patients had their tumours surgically resected with curative intent: 3 implanted≤4 months from starting 1 st -line chemotherapy, 3 implanted at 4–12 months from starting 1 st -line chemotherapy, and 1 implanted≤4 months from starting 2 nd -line chemotherapy; 5/7 (71.4%) patients had R0 resection margins and 2/7 (28.6%) had R1 margins. In 50 patients with imaging follow-up, progressive disease (PD) was more frequently reported at distant sites (26.0%) vs. locally (14.0%) or synchronously (2.0%); 1 (2.0%) patient died without imaging and no PD was observed in 56.0% to date. Median Overall Survival was 20.6 months (95% CI 16.9–20.1) from diagnosis and 17.3 months (95% CI 15.7–23.7) from starting chemotherapy in patients implanted at≤4 months from starting 1 st -line chemotherapy, 22.0 months (95% CI 17.2–22.7) from diagnosis and 20.0 months (95% CI 16.0–22.2) from starting chemotherapy in patients implanted at 4–12 months from starting 1 st -line chemotherapy, and 17.0 months (95% CI 11.3–20.0) from diagnosis and 10.5 months (95% CI 8.4–12.9) from starting 2 nd -line chemotherapy in patients implanted≤4 months from starting 2 nd -line chemotherapy. Conclusions EUS-guided implantation of 32 P microparticles added to chemotherapy for patients with uLAPC receiving routine clinical care was safe and well tolerated, and appears to provide local disease control, downstaging to surgical resection in a proportion of patients and encouraging overall survival. Enrolment in the registry is ongoing and follow-up continues. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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