Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer
Leone F et al. – The current results indicated that induction GEMOX followed by CRT is feasible in patients with LAPC. Both those with borderline resectable disease and those with unresectable disease received clinical benefit, a chance to obtain resectability, and improved survival. The authors concluded that this protocol warrants further evaluation.Methods
- Patients first received induction gemcitabine and oxaliplatin (GEMOX) (gemcitabine 1000 mg/m2, oxaliplatin 100 mg/m2).
- Patients without disease progression then received gemcitabine twice weekly (50 mg/m2 daily) concurrent with radiotherapy (50.4 grays) and were re-evaluated for resectability.
- Thirty-nine patients (15 with borderline resectable disease and 24 with unresectable disease) entered the study.
- The treatment was well tolerated.
- Disease control was obtained in 29 of 39 patients.
- Two patients progressed after GEMOX, and 7 progressed after CRT.
- After a median follow-up of 13 months, the median progression-free survival (PFS) was 10.2 months.
- The median PFS of patients with borderline resectable and unresectable disease was 16.6 and 9.1 months, respectively (P = .056).
- For the whole group, the median overall survival (OS) was 16.7 months (27.8 months for patients with borderline resectable disease, 13.3 for patients with unresectable disease; P = .045).
- Eleven patients (9 with borderline resectable disease and 2 with unresectable disease at diagnosis) underwent successful resection.
- Patients who underwent resection had a significantly longer median PFS compared with nonresected patients (19.7 months vs 7.6 months, respectively).
- The median OS among resected and nonresected patients was 31.5 months and 12.3 months, respectively (P < .001).