Presenter: A.W. Blackstock
Type of Session: Scientific
Pancreatic cancer has a high mortality without significant changes in life expectancy over the past several years
50% have distant disease at diagnosis and cure rates remain low even in locally advanced disease.
Gemcitabine administered twice-weekly produces radiation sensitization at low doses while gemcitabine as a single agent has activity in pancreatic cancer.
This study was performed to evaluate the combination of gemcitabine chemotherapy with radiation therapy
This was a phase II trial of 42 patients with non-metastatic, locally unresectable pancreatic cancer.
Patients received gemcitabine at a dose of 40 mg/m2 twice-weekly (80 mg/m2/wk) during 5 1/2 weeks of radiation therapy (50.4 Gy).
At the completion of the chemoradiation, patients without disease progression received weekly gemcitabine (1000 mg/m2) on days 1, 8 and 15 followed by a week rest and repeated for 5 cycles.
The mean age of the patients was 59 years (range 39-84) with 20 males (48%) enrolled.
Overall, grade III - IV hematologic toxicity occurred in 38% and 12% of patients respectively. Grade III-IV gastrointestinal toxicities occurred in 33% and 2%, respectively. There was 1 death attributed to sepsis.
Chemoradiation portion of the study was completed without treatment delays in 60% of patients and without delays or dose reductions in 36%.
Median follow-up of ~ 16 months, 21% of patients remain alive. The median survival for PS=0 patients was 13.5 months versus 7.8 months in the PS=1 and 2 patients. The median survival for the entire group was 8.5 months. Local failure as a site of initial failure was observed in 4 patients.
28 patients had pre-treatment CA 19-9 levels above 75 U. 20/28 experienced a greater than 75% decrease during treatment. Median survival for the group who had a CA 19-9 decrease was 10.3 months compared to 7.8 months for the other patients.
Concurrent gemcitabine and radiation to the upper abdomen produces manageable toxicity but with results not superior to the conventional 5FU based chemoradiation.
Utilizing this treatment strategy in concert with other cytotoxic/biologic agents is being considered.
Better results are needed before gemcitabine based chemoradiation can be considered a standard therapeutic modality due to the potential side effects.
Utilization of gemcitabine as a XRT sensitizer for the treatment of pancreatic cancer should only be performed in clinical research trials.
Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Bristol-Myers Squibb Oncology and Pharmacia Oncology.
Nov 12, 2010 - Cetuximab in combination with gemcitabine and oxaliplatin shows promise as a first-line palliative care treatment for biliary tract cancers and appears to increase the chance for potentially curative secondary resection, according to the results of a prospective, phase II trial published online Nov. 10 in The Lancet Oncology.