Pancreatic cancer has a poor prognosis. More than 80% of patients present with advanced disease at diagnosis, and mortality is high. A single chemotherapy drug, gemcitabine, is regarded as the standard treatment, but it has lead to a 1-year overall survival of only 17--28% in clinical trials. Various attempts have been made to improve the effectiveness of gemcitabine, by the addition of new or existing drugs, but they have not shown a survival advantage.
Michele Reni (S Raffaele H Scientific Institute, Milan, Italy) and colleagues recruited 104 patients with pancreatic cancer, from five Italian institutions, aged 18-70 years, into a trial to test a combination of chemotherapy drugs against gemcitabine. 52 patients were assigned cisplatin, epirubicin, gemcitabine, and fluorouracil (PEGF regimen) and 47 were assigned gemcitabine alone. More patients assigned PEGF (60%) than gemcitabine alone (28%) were alive without progressive disease after 4 months. The 1-year overall survival was about 40% for patients on PEGF and 20% for patients assigned gemcitabine. Although more patients on PEGF had haematological toxic effects; these were manageable and did not have a detrimental effect on quality of life. The authors state, however, that a larger confirmatory trial may be needed before this combination regimen could be regarded as the new standard treatment.
Dr Reni states: "We have shown that patients allocated PEGF had a more favourable outcome in terms of progression-free survival and overall survival than did those allocated standard treatment with gemcitabine. PEGF might be a feasible and effective first-line treatment for patients with advanced pancreatic cancer."
Contact: Dr Michele Reni, Department of Oncology, San Raffaele H. Scientific Institute, via Olgettina 60, 20132 - Milan, Italy. T) +39-02-26437644 reni.michele@hsr.it
Journal
The Lancet Oncology