Comparison of the efficacy of gemcitabine with capecitabine and gemcitabine with erlotinib combination chemotherapy in recurrent or advanced pancreatic cancer as first-line treatment: Single-center experience.

Abstract

329 Background: We compared the efficacy and toxicity of gemcitabine with capecitabine (GX), and gemcitabine with erlotinib (GT) chemotherapy for recurrent or advanced pancreatic cancer by retrospective analysis. Methods: Between October 2006 and June 2010, 44 patients with recurrent or advanced pancreatic cancer, diagnosed at Seoul St. Mary's hospital were enrolled. In GT group, gemcitabine 1000mg/m2 was administered on days 1, 8, 15, 22, 29, 36, 43 followed by a 1-week rest in first treatment cycle (8 weeks), and then D1, 8, 15 followed by a 1-week rest. Erlotinib was taken orally at 150mg daily through the entire cycle. In GX group, gemcitabine 1000mg/m2 was administered on days 1 and 8. Capecitabine was taken orally at 650mg/m2 twice daily on day 1-14 of a 21-day cycle. Results: In 44 patients, 26 patients were treated with GT, and 18 patients treated with GX. The median age was 56.58 years in GT and 57.67 years in GX. Median number of cycle was 3.04 in GT and 3.57 in GX, and the dose reduction was significantly more common in GX than GT (50% vs. 19%, p=0.031). No complete response was achieved in either group. In GT, partial response and stable disease were achieved in 6 (23.1%) and 8 (30.8%) patients. In GX, partial response and stable disease were shown in 4 (22.2%) and 7 (38.9%) patients, respectively. No significant differences in two patients groups (p=0.442). GX had more favorable clinical outcome of the time to progression (6.1 months vs. 3.0 months, p=0.002) and the overall survival (11.13 months vs. 6.1 months, p=0.012) than GT. The most common grade 3 or 4 toxicity in GT and GX treatment were hematologic toxicity: anemia (8.3%:0%), neutropenia (34.6%:38.8%), thrombocytopenia (15.4%:11.1%). Grade 3 or 4 hand-foot-syndrome of GX was reported in only one patient. Conclusions: GX showed better time to progression and overall survival outcome than GT, but dose reduction was more common. Although there was no significant difference in response rate, and the less dose intensity, GX regimen may be more effective than GT in advanced pancreatic cancer. Further prospective, randomized trials would be warranted in large scale. No significant financial relationships to disclose.

Clinical efficacy and safety of erlotinib combined with chemotherapy in the treatment of advanced pancreatic cancer: A meta-analysis

“…Ten articles[ 9 - 18 ], all of which were randomized controlled trial studies, published between 2007 and 2020, with a total sample size of 2444 patients, were screened. The patients in the control group were treated with gemcitabine, capecitabine, or gemcitabine, whereas those in the study group were treated with gemcitabine or erlotinib.…”

“…All 10 studies[ 9 - 18 ] reported the effect of erlotinib combination chemotherapy on PFS in patients with pancreatic cancer, including 1258 patients in the control group and 1186 patients in the study group. Significant heterogeneity was observed among the studies ( P < 0.0001, I 2 = 73%).…”

Gemcitabine and Erlotinib (GE) Regimen for Pancreatic Cancer

“…The GE regimen (Table 1) is used for treatment of advanced pancreatic cancer. 1–5 GE has also been studied as adjuvant treatment of resectable pancreatic cancer. 6 Current guidelines recommend GE as an option for treating locally advanced or metastatic pancreatic adenocarcinoma.…”

“…1,2 Gastrointestinal: Diarrhea (all grades) 56%, 1 (grade 1 or 2) 29%, 2 (grade 2) 29%, 4 (grade 3) 5%, 4 (grade 3 or 4) 5% to 6% 1,2 ; nausea/vomiting (grade 1 or 2) 21% 2 ; mucositis (grade 2) 8%, 4 (grade 3) 2% 4 ; stomatitis (all grades) 23%, (grade 3 or 4) 1% 1 ; vomiting (grade 2) 10%, 4 (grade 3) 6%. 4 Hematologic: Anemia (grade 1 or 2) 43%, 1 (grade 3) 9% to 19%, 3,4 (grade 3 or 4) 7% to 8% 1,5 ; neutropenia (grade 1 or 2) 19%, 2 (grade 3) 17% to 29%, 3,4 (grade 4) 11%, 4 (grade 3 or 4) 21% to 35% 1,2,5 ; thrombocytopenia (all grades) 11%, 1 (grade 1 or 2) 14%, 2 (grade 3) 11% to 13%, 3,4 (grade 4) 11%, 4 (grade 3 or 4) 10% to 15%. 2,5 Hepatic: Elevations in AST (grade 3 or 4) 11% 1 ; increased transaminases (all grades) 2%, 3 (grade 3) 9%.…”

“…4 Hematologic: Anemia (grade 1 or 2) 43%, 1 (grade 3) 9% to 19%, 3,4 (grade 3 or 4) 7% to 8% 1,5 ; neutropenia (grade 1 or 2) 19%, 2 (grade 3) 17% to 29%, 3,4 (grade 4) 11%, 4 (grade 3 or 4) 21% to 35% 1,2,5 ; thrombocytopenia (all grades) 11%, 1 (grade 1 or 2) 14%, 2 (grade 3) 11% to 13%, 3,4 (grade 4) 11%, 4 (grade 3 or 4) 10% to 15%. 2,5 Hepatic: Elevations in AST (grade 3 or 4) 11% 1 ; increased transaminases (all grades) 2%, 3 (grade 3) 9%. 3 Infections: Infection (grade 2) 3%, 4 (grade 3) 5%, 4 (grade 4) 2%.…”