Cancer Res Treat.  2015 Apr;47(2):266-273. 10.4143/crt.2013.158.

Gemcitabine Combined with Capecitabine Compared to Gemcitabine with or without Erlotinib as First-Line Chemotherapy in Patients with Advanced Pancreatic Cancer

• Lim JY
• Cho JH
• Lee SJ
• Lee DK
• Yoon DS
• Cho JY

• KMID: 2132805
• DOI: http://doi.org/10.4143/crt.2013.158

Abstract

PURPOSE
The purpose of this study is to retrospectively compare the efficacy and tolerability between three regimens for first-line chemotherapy-gemcitabine plus capecitabine (GEM-X), gemcitabine plus erlotinib (GEM-T), and gemcitabine monotherapy (GEM)-in patients with advanced pancreatic cancer.
MATERIALS AND METHODS
There was a total of 127 patients who underwent chemotherapy for pancreatic cancer between January 2007 and November 2011 at our institution. Patients were treated with either GEM (gemcitabine 1,000 mg/m2 on days 1, 8, and 15 every 4 weeks), GEM-T (gemcitabine 1,000 mg/m2 on days 1 and 8 every 3 weeks and erlotinib 100 mg daily), or GEM-X (gemcitabine 1,000 mg/m2 on days 1 and 8 every 3 weeks and capecitabine 850 mg/m2 twice daily for 2 weeks followed by 1 week's rest) as the first-line treatment. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and toxicity were evaluated.
RESULTS
The patient population was divided into groups depending on their first-line treatment: GEM (n=47), GEM-T (n=44), and GEM-X (n=36). GEM-X significantly improved ORR (21.2% vs. 12.7% and 15.9%), PFS (8.9 vs. 5.2 and 3.9 months; p < 0.001), and OS (12.1 vs. 10.4 and 9.9 months; p = 0.03) compared to GEM and GEM-T, respectively. There were higher incidences of some non-hematologic adverse events with GEM-X and GEM-T compared to GEM, but most were grade 1 or 2.
CONCLUSION
GEM-X presented better clinical efficacy and acceptable tolerability than GEM-T and GEM in advanced pancreatic cancers. It is worthy to further investigate which agent has a clinical advantage as a combination drug with gemcitabine in pancreatic cancer and to explore the predictive markers leading to personalize anti-cancer treatment.

Keyword

Pancreatic neoplasms; Drug therapy; Gemcitabine; Capecitabine; Erlotinib

MeSH Terms

Disease-Free Survival
Drug Therapy*
Humans
Incidence
Pancreatic Neoplasms*
Retrospective Studies

Figure

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  Fig. 1. Kaplan-Meier curves for PFS (A) and OS (B) of the GEM (red line), GEM-T (green line), and GEM-X arms (blue line). PFS, progression-free survival; OS, overall survival; GEM, gemcitabine; GEM-T, gemcitabine plus erlotinib; GEM-X, gemcitabine plus capecitabine; HR, hazard ratio; CI, confidence interval.

Reference

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