Chemotherapy with chemoradiation for pancreatic cancer has small survival benefit

March 04, 2008

The addition of the drug gemcitabine with chemoradiation for the treatment of patients who had surgery for pancreatic cancer was associated with a survival benefit, although this improvement was not statistically significant, according to a study in the March 5 issue of JAMA.

Despite the potential benefits of surgically removing cancer involving the pancreas, there is a 50 percent to 85 percent rate of local relapse associated with liver and intra-abdominal failure and a 5-year survival of less than 20 percent, according to background information in the article. The frequency and pattern of failure makes the combination of added postoperative chemotherapy and radiation an important consideration. The drug gemcitabine has been shown to improve outcomes compared with the drug fluorouracil.

William F. Regine, M.D., of the University of Maryland Medical Center, Baltimore, and colleagues conducted a study to assess if the addition of gemcitabine to the supplemental treatment of fluorouracil chemoradiation (chemotherapy plus radiation) improved survival for patients who had a portion of their pancreas removed as a treatment for pancreatic cancer (surgical resection). The randomized controlled phase 3 trial included 451 patients enrolled between July 1998 and July 2002 at 164 U.S. and Canadian institutions, with follow-up through August 2006. Patients received chemotherapy with either fluorouracil (n = 230) or gemcitabine (n = 221) for three weeks prior to chemoradiation therapy and for 12 weeks after chemoradiation therapy (with fluorouracil).

The researchers found that patients with pancreatic head (a part of the pancreas) tumors (n = 388) had a median (midpoint) survival of 20.5 months and 3-year survival of 31 percent in the gemcitabine group vs. 16.9 months and 22 percent in the fluorouracil group. A certain level of hematologic (involving abnormalities in the blood cell counts) toxicity (grade 4) was 1 percent in the fluorouracil group and 14 percent in the gemcitabine group without a difference in neutropenia (a blood disorder) or infection. There were no differences in the ability to complete chemotherapy or radiation therapy.

"The addition of gemcitabine to [supplemental] fluorouracil-based chemoradiation was associated with a survival benefit for patients with resected pancreatic cancer, although this improvement was not statistically significant," the authors write.

Patients in the study had the lowest rate of cancer recurring in its original location than in other previous studies. The tumor came back in the same area in 23 percent of the patients, compared to 40 percent to 60 percent of patients in other studies. At least 70 percent of the patients in this study experienced spread of their cancer to other parts of the body, a process that is known as systemic metastasis.

"Laboratory correlative studies from [this trial] are ongoing and are evaluating molecular genetic alterations that promote local and systemic relapse. Future trials should emphasize novel systemic treatments to reduce systemic metastases and modern image-guided radiation to prevent local recurrence while reducing radiation-related toxic effects."

(JAMA. 2008;299[9]:1019-1026. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.




Editorial: Adjuvant Therapy for Surgically Resected Pancreatic Adenocarcinoma

In an accompanying editorial, James L. Abbruzzese, M.D., of the University of Texas M. D. Anderson Cancer Center, Houston, offers suggestions on how to improve outcomes for pancreatic cancer patients with surgical resection.

"First, the lessons regarding the optimal selection of patients for surgical resection need to be exported more effectively into the high-surgical volume setting. ... Second, further work is needed to determine which patients are most likely to benefit from chemoradiation and, if this modality is going to evolve, further emphasis should be placed on the development of more effective radiation sensitizers."

"Third, based on interindividual differences in drug metabolism and DNA repair, it appears that patients who are more likely to benefit from current chemotherapy and chemoradiation strategies can be defined prospectively. These individualized approaches should be examined in prospective clinical trials.

Finally, and most importantly, efforts must be redoubled to develop a new generation of promising therapeutics, and the commitment must be increased to understand and test them in prospectively defined patient subsets--not the means to detect marginal or incremental improvements in clinical trials of large numbers of unselected patients."
-end-
(JAMA. 2008;299[9]:1066-1067. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.

The JAMA Network Journals

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.