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Chemotherapy with fluorouracil or gemcitabine may be optimal adjuvant therapy for pancreatic cancer
Regimens containing fluorouracil or gemcitabine were associated with improved outcomes and lower toxicity than radiation-containing regimens among a cohort of patients with pancreatic adenocarcinoma, according to results of a systematic review and meta-analysis.
Several adjuvant treatments are used for pancreatic adenocarcinoma, including fluorouracil, gemcitabine (Gemzar, Eli Lilly), chemoradiation, chemoradiation plus fluorouracil, and chemoradiation plus gemcitabine. However, the optimal therapy remains inconclusive.
Wei-Chih Liao, MD, of the department of internal medicine at National Taiwan University Hospital, and colleagues conducted the investigation to compare OS and toxicities for these five regimens in a cohort of patients who underwent tumor resection.
The researchers used PubMed, trial registries, and other reviews and abstracts to identify randomized controlled trials. They identified 10 eligible studies conducted prior to April 30, 2013.
Compared with observation, HRs for mortality were 0.62 (95% CI, 0.42-0.88) for fluorouracil, 0.68 (95% CI, 0.44-1.07) for gemcitabine, 0.91 (95% CI, 0.55-1.46) for chemoradiation, 0.54 (95% CI, 0.15-1.80) for chemoradiation plus fluorouracil, and 0.44 (95% CI, 0.10-1.81) for chemoradiation plus gemcitabine.
Researchers observed an inverse association between the ratio of patients with positive lymph nodes and survival benefit of adjuvant therapy. Adjusted results indicated that fluorouracil (HR=0.65; 95% CI, 0.49-0.84) and gemcitabine (HR=0.59; 95% CI, 0.41-0.83) were associated with prolonged survival compared with observation. The adjusted analysis results also demonstrated poorer survival among patients who underwent chemoradiation compared with those treated with fluorouracil (HR=1.69; 95% CI, 1.12-2.54) and gemcitabine (HR=1.86; 95% CI, 1.04-3.23).
Chemoradiation plus gemcitabine was the most toxic regimen. It demonstrated significantly more hematological toxicity than the next most toxic regimen, chemoradiation plus fluorouracil (OR=13.33; 95% CI, 1.01-169.36).
“Chemotherapy with fluorouracil or gemcitabine is the optimum adjuvant treatment for pancreatic adenocarcinoma and reduces mortality after surgery by about a third,” the researchers concluded. “Adding chemoradiation to chemotherapy provides little further survival benefit but increases toxic effects.”
Disclosure: The researchers report no disclosures.