Source: Hong Kong Med J  |  Posted 7 years ago

By Cameron E. Johnston

ORLANDO, FL -- May 17, 2005 -- Patients with locally advanced pancreatic cancer who do not show signs of further metastasis after 3 months of chemotherapy appear to benefit from an additional regimen of radiation and 5-fluorouracil (5-FU).

The finding was presented in poster form here on May 14[^]th[] at the American Society of Clinical Oncology Annual Meeting (ASCO).

Florence Huguet, radiation oncologist, H?pital Tenon, Paris, France, who presented the data, said these results are important because locally advanced pancreatic cancer (LAPC) is probably the most aggressive form of the disease and typically, regardless of the initial therapy, survival rarely exceeds 10 months.

There is no standard therapy for LAPC, Dr. Huguet said, and physicians frequently have little choice other than to use whatever therapy is available that the patient can tolerate.

In this study, Dr. Huguet and colleagues conducted a retrospective analysis of patients who received treatment regimens that included gemcitabine, 5-FU and leucovorin, gemcitabine and oxaliplatin, or gemcitabine alone. At the end of 3 months, patients who had no further metastasis had the option of either continuing their chemotherapy or receiving radiation plus 5-FU. Patients who had progressive metastasis did not participate in the rest of the study.

The 2 treatment groups were matched for baseline characteristics (most were male, mean age was 61 years, and 80% had a Eastern Cooperative Oncology Group performance status of 0 to 1).

The 72 patients in the radiation group received 1.8 Gy per day, 5 days per week for 5 weeks, plus 5-FU 250 mg/m[^]2[] in continuous infusions every day for 5 weeks. The 56 patients in the chemotherapy group continued on their original regimens.

Complete or partial response was seen in 32% of patients who received radiation therapy compared with 25% who remained on chemotherapy alone. Clinical benefit was seen in 63.2% compared with 51.8%, respectively. By comparison, 48% of the chemotherapy group and 38% in the radiation arm showed no further response.

Survival results show a 65.3% 1-year survival rate for the radiation arm compared to 47.5% for the chemotherapy alone arm. This finding was very encouraging, Dr. Huguet said, and noted that progression-free survival was 47 weeks and overall survival was a mean of 65 weeks.

Median overall survivals were 15 months and 11.7 months, respectively, which represents a significant benefit, given that so many people with pancreatic cancer die within 1 year, she said. In fact, 30% of patients originally considered for the study did not continue because they had disease progression within the first 3 months, so that further treatment would not have offered them any advantage.

Dr. Huguet suggested that patients' response after 3 months of initial chemotherapy might be a good indicator of whether or how well they will respond to further radiation. If they do not have progressive disease in the initial 3-month period, they might achieve more benefit from addition of radiation than from continued chemotherapy alone.

"After control of the disease has been established with induction chemotherapy, additional chemotherapy plus radiation could improve survival in these patients more than chemotherapy alone," she said, adding that a prospective validation will still be necessary to prove this data.

[Presentation title: Chemoradiotherapy (CRT) After Chemotherapy (CT) Improves Survival for Locally-Advanced (LA) Pancreatic Cancer Patients: Retrospective Analysis of 181 Patients Enrolled in Prospective Phases II and III GERCOR Studies. Abstract 4095]