26 February 2010
Palliative first-line treatment with weekly high-dose 5-fluorouracil as 24h-infusion and gemcitabine in metastatic pancreatic cancer (UICC IV)Sandra RoehrigABDEF, Axel WeinABCDEF, Heinz AlbrechtBD, Peter C. KonturekDE, Udo ReulbachCDE, Gudrun MannleinEF, Kerstin WolffBD, Nicola OstermeierBD, Werner HohenbergerAD, Eckhart G. HahnAD, Frank BoxbergerABCDEF
Med Sci Monit 2010; 16(3): CR124-131 :: ID: 878461
The aim of this study was to evaluate the efficacy and toxic side effects of combined gemcitabine plus weekly high-dose 5-Fluorouracil (5-FU) as 24h-infusion in patients with metastatic pancreatic cancer (UICC IV) as validation group of an earlier phase II study. Primary endpoints were to assess the response and tumour control rate.
Material and Method
This study comprised 60 prospectively registered patients with metastatic pancreatic cancer (UICC IV). A locally advanced disease was defined as exclusion criteria. The treatment schedule was weekly gemcitabine (1.000 mg/m(2)) as a 0.5h-infusion combined with 5-FU (2.000 mg/m(2)) as a 24h-infusion on day 1, 8 and 15 every 28 days.
Response rate (CR+PR) was achieved in 7% of the patients, tumour control rate (CR+PR+SD) was achieved in 59%. Median time-to-progression was 4 months, median overall survival was 7.3 months (95% CI 5.4-9.1). The median survival of patients with normal CEA value was 10.6 months (95% CI 7.8-13.4); with a normal CA 19-9 median survival was 10.1 months (95% CI 4.6-15.7) and with ECOG performance status 0 median survival was 10.1 months (95% CI 8.6-15.3). As higher grade toxicity (grade 3/4) leukopenia (15%), anaemia (10%) and thrombopenia (5%) were observed. Nausea and diarrhea (grade 3/4) occurred in 5% of the patients and vomiting in 2%.
The administration of gemcitabine and 5-FU as a 24h-infusion is feasible and offers good tumour control rate accompanied by tolerable toxicity. The subgroup of patients with a good performance status (ECOG 0) and tumour markers within the normal range benefit from the gemcitabine combination therapy.
Keywords: Prognosis, Pancreatic Neoplasms - drug therapy, Neoplasm Metastasis, Palliative Care, Kaplan-Meier Estimate, Infusions, Intravenous, Fluorouracil - therapeutic use, Dose-Response Relationship, Drug, Drug Administration Schedule, Deoxycytidine - therapeutic use, Clinical Trials, Phase II as Topic, Carcinoembryonic Antigen - metabolism, Antineoplastic Combined Chemotherapy Protocols - therapeutic use, Antineoplastic Agents - therapeutic use, Time Factors, Tumor Markers, Biological - metabolism, United States
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