Chemotherapy Combination Shows Prolonged Survival in Pancreatic Cancer

Pancreatic cancer patients given capecitabine chemotherapy in combination with gemcitabine achieved prolonged survival after surgery.

Findings from the phase 3 trial were presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

The European Study Group for Pancreatic Cancer (ESPAC) is the second largest clinical trial using pancreatic cancer patients who had undergone surgery. Researchers enrolled 732 randomized patients with early-stage pancreatic ductal adenocarcinoma to receive gemcitabine alone or in combination with capecitabine for 24 weeks within 12 weeks of surgery.

The results of the study found that patients in the combination therapy arm had a median overall survival rate of 28 months compared with 25.5 months in the gemcitabine alone arm.

Estimated 5-year survival rates in the 2 groups were 28.8% versus 16.3%, respectively.

“The difference in median survival might seem modest, but the improvement in long term survival is substantial for this cancer,” said lead study author John P. Neoptolemos, MA, MB, BChir, MD, FMedSci. “We’ve gone from a 5-year survival rate of 8% with surgery along to nearly 30% with adjuvant therapy.”

Authors noted that the study patients represented real world pancreatic cancer populations with a large amount of patients who had unfavorable prognostic factors, such as aggressive or locally advance disease, a large tumor, or the incomplete removal of the tumor.

The adverse events overall were similar among the groups, with severe diarrhea found to be slightly more common in patients administered combination therapy (14 versus 5 patients, respectively), as well as fatigue (16 versus 14 patients, respectively).

The quality of life was found to be comparable among the 2 arms.

“Unfortunately, most patients are not candidates for surgery when they are diagnosed with pancreatic cancer,” Neoptolemos said. “These findings are significant because they show that those patients who can undergo surgery have a fighting chance of surviving this cancer with the combination of 2 commonly used chemotherapies.”

Future research will focus on developing tests that are able to predict which patients would most likely benefit from adjuvant therapy.