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Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer
A single institutional experience
Article first published online: 6 JUL 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 2, pages 277–284, 15 January 2013
How to Cite
Leone, F., Gatti, M., Massucco, P., Colombi, F., Sperti, E., Campanella, D., Regge, D., Gabriele, P., Capussotti, L. and Aglietta, M. (2013), Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer. Cancer, 119: 277–284. doi: 10.1002/cncr.27736
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- Issue published online: 4 JAN 2013
- Article first published online: 6 JUL 2012
- Manuscript Accepted: 7 JUN 2012
- Manuscript Revised: 5 JUN 2012
- Manuscript Received: 3 MAR 2012
- pancreatic neoplasm;
- locally advanced;
- combined modality therapy;
- neoadjuvant treatment
Chemoradiotherapy (CRT) may render curative resection feasible in patients with locally advanced pancreatic carcinoma (LAPC). The authors previously demonstrated the achievement of significant disease control and a median survival of 14 months by CRT in patients with LAPC. In this study, they evaluated the use of induction chemotherapy followed by a CRT neoadjuvant protocol.
Patients first received induction gemcitabine and oxaliplatin (GEMOX) (gemcitabine 1000 mg/m2, oxaliplatin 100 mg/m2). Patients without disease progression then received gemcitabine twice weekly (50 mg/m2 daily) concurrent with radiotherapy (50.4 grays) and were re-evaluated for resectability.
Thirty-nine patients (15 with borderline resectable disease and 24 with unresectable disease) entered the study. The treatment was well tolerated. Disease control was obtained in 29 of 39 patients. Two patients progressed after GEMOX, and 7 progressed after CRT. After a median follow-up of 13 months, the median progression-free survival (PFS) was 10.2 months. The median PFS of patients with borderline resectable and unresectable disease was 16.6 and 9.1 months, respectively (P = .056). For the whole group, the median overall survival (OS) was 16.7 months (27.8 months for patients with borderline resectable disease, 13.3 for patients with unresectable disease; P = .045). Eleven patients (9 with borderline resectable disease and 2 with unresectable disease at diagnosis) underwent successful resection. Patients who underwent resection had a significantly longer median PFS compared with nonresected patients (19.7 months vs 7.6 months, respectively). The median OS among resected and nonresected patients was 31.5 months and 12.3 months, respectively (P < .001).
The current results indicated that induction GEMOX followed by CRT is feasible in patients with LAPC. Both those with borderline resectable disease and those with unresectable disease received clinical benefit, a chance to obtain resectability, and improved survival. The authors concluded that this protocol warrants further evaluation. Cancer 2013. © 2012 American Cancer Society.