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Chemotherapy helps pancreatic cancer survivors

By DR. V. UPENDER RAO
Published January 22, 2007

Eileen O'Reilly, M.D., of the Memorial Sloan-Kettering Cancer Center in New York, and Henry Q. Xiong, M.D., Ph.D., of the M.D. Anderson Cancer Center in Texas, addressed a recent pancreatic cancer symposium in New York. They discussed the role of chemotherapy for patients who have had complete surgical resection of early pancreatic cancer and also for those who have a more advanced disease.

O'Reilly pointed out the results of a Phase 3 clinical trial of 356 patients (reported at the 2005 American Society of Clinical Oncology) with pancreatic cancer who were either treated with gemcitabine, which is a cancer chemotherapeutic drug, or observed without any treatment after complete resection of pancreatic cancer.

Patients who received chemotherapy survived twice as long as those who did not receive any further treatment.

She also discussed the results of another study of 4,442 patients who had surgery for early stage pancreatic cancer. These patients either received gemcitabine or 5-fluorouracil-based chemotherapy after surgery.

Patients in the gemcitabine arm of the trial had a superior median survival. Thirty-one percent of the patients were alive at three years compared with 21 percent in the 5-fluorouracil arm. Based upon this and other evidence in the literature, she said, "We do endorse the use of chemotherapy postoperatively."

Speaking at the same symposium, Xiong said that several European trials indicated that chemotherapy after surgery for pancreatic cancer can reduce the risk of recurrence. He also said that the role of radiation in addition to chemotherapy in the postoperative setting is much debated but still unclear, and that the European Organization for Research and Treatment of Cancer is currently conducting a Phase 2/3 trial to clarify this issue.

Another study reported in the Jan. 17 issue of the Journal of the American Medical Association further fortifies the role of gemcitabine chemotherapy for patients with complete surgical resection of early stage pancreatic cancer.

Researchers from Germany and Austria treated 368 pancreatic cancer patients after surgery with either six cycles of gemcitabine chemotherapy or no further therapy. They observed a median survival of 13.9 months in the gemcitabine group vs. 6.9 months in the no treatment group.

Estimated disease-free survival at three and five years was 23.5 percent and 16.5 percent, respectively, in the gemcitabine group and 7.5 percent and 5.5 percent in the no treatment group.

The authors of this study concluded, "Postoperative gemcitabine significantly delayed the development of recurrent disease after complete resection of pancreatic cancer compared with observation alone. These results support the use of gemcitabine as adjuvant chemotherapy in respectable carcinoma of the pancreas."

The role of chemotherapy in advanced, inoperable patients with pancreatic cancer is well-recognized. The combined results of 29 randomized trials consisting of 3,458 patients establish the superiority of 5-fluorouracil-based chemotherapy compared to best supportive care in terms of improved survival for the treated patients. Newer data show even better results with gemcitabine-based chemotherapy.

Worldwide, more than 230,000 cases of pancreatic cancer are diagnosed each year. In 2006, 32,000 deaths were attributed to pancreatic cancer in the United States alone. The estimated five-year survival following complete surgical resection of pancreatic cancer is only 23.4 percent. Therefore, it is obvious that surgery as a sole treatment modality is inadequate.

From the results of the clinical trials discussed above it is clear that adjuvant gemcitabine chemotherapy after presumed complete surgical resection of localized pancreatic cancer is well-tolerated and offers the best chance of long-term survival today.

V. Upender Rao, M.D., FACP, practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified January 21, 2007, 21:58:31]