Impact of Chemoradiotherapy After Disease Control With Chemotherapy in Locally Advanced Pancreatic Adenocarcinoma in GERCOR Phase II and III Studies

Abstract

These results suggest that, after control of disease by initial CT, CRT could significantly improve survival in patients with LA pancreatic cancer compared with CT alone. A prospective phase III study is ongoing to evaluate this strategy.

Gemcitabine with a specific conformal 3D 5FU radiochemotherapy technique is safe and effective in the definitive management of locally advanced pancreatic cancer

“…Our focus has been on optimising outcomes in the absence of any further surgery. The use of initial chemotherapy allows identification of rapidly progressing patients who do not then undergo prolonged inappropriate therapy, and may also delay the emergence of systemic disease, enhancing the benefit of local control (Moureau-Zabotto et al, 2006;Rana et al, 2006;Huguet et al, 2007). Despite our finding of some impact on the postradiotherapy dose intensity and the significant loss of patients due to disease progression or personal decisions during treatment, current chemotherapy agents do not have a high enough response rate for the CRT to be confidently delayed until the completion of a standard 6-month chemotherapy programme, considering the significant problems associated with local progression in tumours that fail to respond to chemotherapy.…”

“…Despite our finding of some impact on the postradiotherapy dose intensity and the significant loss of patients due to disease progression or personal decisions during treatment, current chemotherapy agents do not have a high enough response rate for the CRT to be confidently delayed until the completion of a standard 6-month chemotherapy programme, considering the significant problems associated with local progression in tumours that fail to respond to chemotherapy. Delaying radiotherapy until month 4 has been proposed on the basis of a recent retrospective outcome analysis (Huguet et al, 2007) and seems to be a pragmatic compromise until the emerging novel targeted agents can be shown to have contributed sufficiently to allow reconsideration of radiotherapy and chemotherapy scheduling.…”

Chemoradiotherapy with concurrent gemcitabine and cisplatin with or without sequential chemotherapy with gemcitabine/cisplatin vs chemoradiotherapy with concurrent 5-fluorouracil in patients with locally advanced pancreatic cancer – a multi-centre randomised phase II study

“…Novel treatment concepts in LAPC are, for example, based on a 'biological' patient selection by systemic induction chemotherapy. Two study groups recently reported data on such an approach, where all LAPC patients receive initial systemic chemotherapy for 2 -3 cycles and only patients with disease control carried on with CRT (Huguet et al, 2007;Krishnan et al, 2007). Prospective data from phase III trials that confirm a survival advantage for such a treatment regimen are still lacking; however, phase II data have shown the feasibility and tolerance of these concepts (Ko et al, 2007;Moureau-Zabotto et al, 2008).…”

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016

“…Some experts advocate for treatment with concurrent chemotherapy and radiation therapy because of the local control benefit that radiation therapy might provide. A retrospective analysis of phase ii and iii trials from the Groupe Coopérateur Multidisciplinaire en Oncologie suggested that, compared with maintenance chemotherapy alone, combined-modality chemoradiation in patients who have not progressed after initial induction chemotherapy might improve os 36 . In patients with lapc who achieved disease control after induction with gemcitabine, a prospective phase iii rct looked at whether, compared with maintenance gemcitabine, chemoradiation (54 Gy and capecitabine 1600 mg/ m 2 daily) after induction chemotherapy would improve survival 37 .…”