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Dose finding and early efficacy study of gemcitabine plus capecitabine in combination with bevacizumab plus erlotinib in advanced pancreatic cancer
Journal of Clinical Oncology, 11/03/09

Starling N et al. – This study evaluated safety and efficacy of chemotherapy (gemcitabine plus capecitabine) plus bevacizumab/erlotinib in advanced pancreatic cancer because dual epidermal growth factor receptor/vascular endothelial growth factor blockade has a rational biologic basis in this malignancy.The maximum-tolerated dose of capecitabine was 1,660 mg/m2. The recommended capecitabine dose in this cytotoxic doublet/biologic doublet regimen is 1,440 mg/m2; this regimen is under evaluation in an ongoing phase II study.

Methods

Patients with untreated, unresectable, locally advanced or metastatic pancreatic carcinoma enrolled onto one of 4 sequential dose levels (DLs) of escalating capecitabine doses (days 1 to 21): DL1, 910 mg/m2; DL2, 1,160 mg/m2; DL3, 1,400 mg/m2; or DL4, 1,660 mg/m2
Doses of coadministered gemcitabine (1,000 mg/m2 on days 1, 8, and 15), bevacizumab (5 mg/kg on days 1 and 15), and erlotinib (100 mg/d) every 28 days (up to six cycles) were fixed
Using a 3+3 study design, dose-limiting toxicity (DLT) assessed in cycle 1

Results

20 assessable patients enrolled (DL1, n = 8; DL2, n = 3; DL3, n = 6; and DL4, n = 3)
97 cycles administered
Median age 63 years (range, 33 to 77 years), and male-to-female ratio 10:10
Performance status 0 and 1 in two and 17 patients, respectively; and nine and 11 patients had locally advanced and metastatic disease, respectively
DLT occurred in 1 patient at DL1 (grade 3 epistaxis) and 2 patients at DL4 (grade 3 diarrhea and grade 3 skin rash > 7 days)
Common grade 3 and 4 toxicities (10% to 20%) diarrhea, hand-foot syndrome, stomatitis, and skin rash
Grade 3 lethargy and grade 3 or 4 neutropenia occurred in 40% and 45% of patients, respectively
No GI perforation, grade 3 GI hemorrhage/hypertension, or pneumonitis occurred
10 partial responses observed
Median overall and progression-survival times (all patients) 12.5 and 9.0 months, respectively

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