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Sequential gemcitabine and platinum versus first-line combination of gemcitabine and platinum for advanced pancreatic cancer treatment: a retrospective study

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Abstract

Objective

The purpose of this study was to investigate the impact of combinational versus sequential gemcitabine and platinum on prognosis of advanced pancreatic cancer.

Methods

Two hundred and three patients with advanced pancreatic cancer were selected. They were divided into GemP (first-line gemcitabine and platinum), Gem-then-P (sequential gemcitabine and platinum), Gem/other (first-line gemcitabine-based therapy without subsequent platinum), and Gem (first-line gemcitabine-based therapy without subsequent systemic therapy) groups. The Kaplan–Meier method and log-rank test were used for survival analyses. Cox regression model and propensity score matching were used for prognostic analyses.

Results

The median survival was 12.5 months [95 % confidence interval (CI), 11.2–13.7] in the GemP group (N = 65), 8.3 months (95 % CI 5.0–11.7) in the Gem-then-P group (N = 35), 11.6 months (95 % CI 4.6–18.5) in the Gem/other group (N = 26), and 4.7 months (95 % CI 3.3–6.0) in the Gem group (N = 77) (P < 0.001). Considering the GemP and Gem-then-P groups, performance status, serum creatinine, and response to first-line treatment were independent prognostic factors for overall survival in the multivariate analysis. No specific factors were identified for predicting the choice between GemP and Gem-then-P.

Conclusions

First-line gemcitabine and platinum-based combinations were not superior to sequential gemcitabine and platinum for overall survival. The best sequence of chemotherapy for advanced pancreatic cancer should be explored in future clinical trials.

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References

  1. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  2. Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413

    CAS  PubMed  Google Scholar 

  3. Moore MJ, Goldstein D, Hamm J et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25:1960–1966

    Article  CAS  PubMed  Google Scholar 

  4. Cunningham D, Chau I, Stocken DD et al (2009) Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol 27:5513–5518

    Article  CAS  PubMed  Google Scholar 

  5. Kindler HL, Niedzwiecki D, Hollis D et al (2010) Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol 28:3617–3622

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Philip PA, Benedetti J, Corless CL et al (2010) Phase III study comparing gemcitabine plus cetuximab versus gemcitabine in patients with advanced pancreatic adenocarcinoma: Southwest Oncology Group-directed intergroup trial S0205. J Clin Oncol 28:3605–3610

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Kindler HL, Ioka T, Richel DJ et al (2011) Axitinib plus gemcitabine versus placebo plus gemcitabine in patients with advanced pancreatic adenocarcinoma: a double-blind randomised phase 3 study. Lancet Oncol 12:256–262

    Article  CAS  PubMed  Google Scholar 

  8. Colucci G, Giuliani F, Gebbia V et al (2002) Gemcitabine alone or with cisplatin for the treatment of patients with locally advanced and/or metastatic pancreatic carcinoma: a prospective, randomized phase III study of the Gruppo Oncologia dell’Italia Meridionale. Cancer 94:902–910

    Article  CAS  PubMed  Google Scholar 

  9. Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23:3509–3516

    Article  CAS  PubMed  Google Scholar 

  10. Heinemann V, Quietzsch D, Gieseler F et al (2006) Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 24:3946–3952

    Article  CAS  PubMed  Google Scholar 

  11. Poplin E, Feng Y, Berlin J et al (2009) Phase III, randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 27:3778–3785

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Colucci G, Labianca R, Di Costanzo F et al (2010) Randomized phase III trial of gemcitabine plus cisplatin compared with single-agent gemcitabine as first-line treatment of patients with advanced pancreatic cancer: the GIP-1 study. J Clin Oncol 28:1645–1651

    Article  CAS  PubMed  Google Scholar 

  13. Sultana A, Smith CT, Cunningham D et al (2007) Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25:2607–2615

    Article  PubMed  Google Scholar 

  14. Heinemann V, Boeck S, Hinke A et al (2008) Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer. BMC Cancer 8:82

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ciliberto D, Botta C, Correale P et al (2013) Role of gemcitabine-based combination therapy in the management of advanced pancreatic cancer: a meta-analysis of randomised trials. Eur J Cancer 49:593–603

    Article  CAS  PubMed  Google Scholar 

  16. Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825

    Article  CAS  PubMed  Google Scholar 

  17. Ch’ang HJ, Huang CL, Wang HP et al (2009) Phase II study of biweekly gemcitabine followed by oxaliplatin and simplified 48-h infusion of 5-fluorouracil/leucovorin (GOFL) in advanced pancreatic cancer. Cancer Chemother Pharmacol 64:1173–1179

    Article  PubMed  Google Scholar 

  18. Boeck S, Hinke A, Wilkowski R et al (2007) Importance of performance status for treatment outcome in advanced pancreatic cancer. World J Gastroenterol 13:224–227

    Article  PubMed Central  PubMed  Google Scholar 

  19. Heinemann V, Vehling-Kaiser U, Waldschmidt D et al (2013) Gemcitabine plus erlotinib followed by capecitabine versus capecitabine plus erlotinib followed by gemcitabine in advanced pancreatic cancer: final results of a randomised phase 3 trial of the ‘Arbeitsgemeinschaft Internistische Onkologie’ (AIO-PK0104). Gut 62:751–759

    Article  CAS  PubMed  Google Scholar 

  20. Pelzer U, Schwaner I, Stieler J et al (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47:1676–1681

    Article  CAS  PubMed  Google Scholar 

  21. Yang SH, Kuo YH, Tien YW et al (2011) Inferior survival of advanced pancreatic cancer patients who received gemcitabine-based chemotherapy but did not participate in clinical trials. Oncology 81:143–150

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank the Cancer Registry, Medical Information Management Office, and National Taiwan University Hospital for their great help in the screening of patients.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oncology, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan

    Jhe-Cyuan Guo

  2. Department of Oncology, National Taiwan University Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, Taiwan

    Shih-Hung Yang

  3. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Shih-Hung Yang

Authors
  1. Jhe-Cyuan Guo
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  2. Shih-Hung Yang
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Correspondence to Shih-Hung Yang.

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Guo, JC., Yang, SH. Sequential gemcitabine and platinum versus first-line combination of gemcitabine and platinum for advanced pancreatic cancer treatment: a retrospective study. Int J Clin Oncol 19, 634–642 (2014). https://doi.org/10.1007/s10147-013-0622-x

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  • DOI: https://doi.org/10.1007/s10147-013-0622-x

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