Chemotherapy combo prolongs survival in pancreatic cancer

6 Jun 2016

A European phase 3 trial, one of the largest ever conducted in pancreatic cancer, showed that adding the oral drug capecitabine chemotherapy to gemcitabine prolongs survival without increased toxicity. Adjuvant gemcitabine chemotherapy is currently the standard of care worldwide after surgical removal of pancreatic cancer.

“Unfortunately, most patients are not candidates for surgery when they are diagnosed with pancreatic cancer,” said lead study author John P. Neoptolemos, MA, MB, BChir, MD, FMedSci, the chair of surgery in the Department Molecular and Clinical Cancer Medicine at the University of Liverpool in Liverpool, United Kingdom. “These findings are significant because they show that those patients who can undergo surgery have a fighting chance of surviving this cancer with the combination of two commonly used chemotherapies.”

Gemcitabine is an intravenous chemotherapy used as a standard adjuvant treatment for early pancreatic cancer. In the United States, gemcitabine is also approved to treat patients with breast, ovarian and lung cancer. Capecitabine is an oral chemotherapy drug approved in the United States for treatment of patients with breast and colorectal cancers. Gemcitabine and capecitabine are both available as generic drugs.

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Substantial improvement in long-term survival

With 732 patients, the European Study Group for Pancreatic Cancer (ESPAC) 4 trial is the second-largest clinical trial ever conducted in patients with pancreatic cancer who had undergone surgery. Within 12 weeks of surgery, patients with early-stage pancreatic ductal adenocarcinoma were randomly assigned to receive either gemcitabine alone or gemcitabine with capecitabine for 24 weeks.

According to the authors, the patient characteristics were representative of a real-world pancreatic cancer population. A large proportion of patients had unfavorable prognostic factors, such as locally advanced or aggressive disease, large tumor size, or incomplete removal of the tumor. The survival advantage with the combination regimen was similar irrespective of such factors. In particular:

  • The median overall survival was 28.0 months with the combination regimen vs. 25.5 months with gemcitabine alone.
  • The estimated 5-year survival rates were 28.8% vs. 16.3% in the two groups.
  • Patients who had been smokers but stopped smoking after their diagnosis had better outcomes than those who continued smoking.
  • Overall, there were no major differences in the types and severity of side effects between the two groups.
  • Severe diarrhea was slightly more common with the combination regimen (14 vs. 5 patients), as was fatigue (16 vs. 14 patients).
  • Quality of life was also comparable between the two groups.

“The difference in median survival may seem modest, but the improvement in long-term survival is substantial for this cancer,” said Dr. Neoptolemos. “We’ve gone from a five-year survival rate of 8% with surgery alone to nearly 30% with adjuvant therapy.”

The safety of this new gemcitabine-capecitabine chemotherapy regimen opens the opportunity to add other treatments to this combination, which might further improve outcomes for patients. Future research efforts will focus on developing tests to predict which patients would benefit most from a particular adjuvant therapy.

Source: eCancer News
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