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Cancer and leukemia group B (CALGB) 89805

Phase II chemoradiation trial using gemcitabine in patients with locoregional adenocarcinoma of the pancreas

  • Clinical Trial
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Abstract

Purose. Determine the safety and efficacy of twice weekly gemcitabine and concurrent radiation to the upper abdomen followed by weekly gemcitabine in patients with surgically staged, locally advanced pancreatic cancer.

Methods. Patients with surgically staged, locally advanced, nonmetastatic adenocarcinoma of the pancreas were treated with intravenous gemcitabine administered twice weekly (40 mg/m2/d) for 5 wk concurrent with upper abdominal radiation (50.4 Gy in 180 cGy daily fractions over 5.5 wk). At the completion of the chemoradiation, patients without disease progression were given gemcitabine (1000 mg/m2) weekly for five cycles. Each cycle consisted of 3 wk of treatment followed by 1 wk without treatment. Disease progression and response were assessed at 6- to 8-wk intervals.

Results. From February through December 1999, 43 patients were entered into this phase II trial, 39 of whom were evaluable for treatment response. The median age was 59 yr (range: 39–84 yr); there were 18 males (47%) in the study. Grade III and IV hematologic toxicity occurred in 48 and 21% of patients, respectively, and was primarily leukocytopenia and neutropenia. Grade III and IV gastrointestinal toxicities occurred in 31 and 10% of patients, respectively. There was one death attributed to sepsis. The concurrent gemcitabine and radiation portion of the study was completed without treatment interruptions in 56% of patients. The overall median survival was 8.2 mo and the median survival in the 44% of patients demonstrating a sustained CA-19-9 response was 13.5 mo. Only six patients experienced local regional progression as their first site of failure. Two patients (5%) were still alive at 35 and 41 mo posttreatment.

Conclusions. These results confirm the feasibility of twice weekly gemcitabine and radiation for the treatment of pancreatic cancer. Although this treatment strategy produced good local regional control, this did not result in a survival advantage. Stratifying patients by performance status and CA-19-9 response in future trials may be of value.

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Authors and Affiliations

  1. Radiation Oncology, Wake Forest University Comprehensive Cancer Center, Winston-Salem, NC

    A. William Blackstock MD

  2. Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC

    Joel E. Tepper

  3. Cancer Center Biostatistics, Duke University Medical Center, Durham, NC

    Donna Niedwiecki & Donna R. Hollis

  4. Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Bostor, MA

    Robert J. Mayer

  5. Division of Medical Oncology, University of California, San Francisco, San Francisco, CA

    Margaret A. Tempero

Authors
  1. A. William Blackstock MD
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  2. Joel E. Tepper
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  3. Donna Niedwiecki
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  4. Donna R. Hollis
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  5. Robert J. Mayer
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  6. Margaret A. Tempero
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Correspondence to A. William Blackstock MD.

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William Blackstock, A., Tepper, J.E., Niedwiecki, D. et al. Cancer and leukemia group B (CALGB) 89805. Int J Gastrointest Canc 34, 107–116 (2003). https://doi.org/10.1385/IJGC:34:2-3:107

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