Cancer Chemotherapy and Pharmacology

, Volume 69, Issue 1, pp 115–123

A randomized phase II trial of two different 4-drug combinations in advanced pancreatic adenocarcinoma: cisplatin, capecitabine, gemcitabine plus either epirubicin or docetaxel (PEXG or PDXG regimen)

  • Michele Reni
  • Stefano Cereda
  • Alessia Rognone
  • Carmen Belli
  • Michele Ghidini
  • Simonetta Longoni
  • Clara Fugazza
  • Sara Rezzonico
  • Paolo Passoni
  • Najla Slim
  • Giampaolo Balzano
  • Roberto Nicoletti
  • Stefano Cappio
  • Claudio Doglioni
  • Eugenio Villa
Original Article



PEFG regimen (P:cisplatin, E:epirubicin, F:5-fluorouracil, G:gemcitabine) significantly prolonged progression-free (PFS) and overall survival (OS) of patients with advanced pancreatic adenocarcinoma (PA) with respect to standard gemcitabine. The current trial was aimed at assessing whether the replacement of E with docetaxel (D) may improve 6 months PFS (PFS6).


Chemo-naive patients with stage III or metastatic PA received P (30 mg/m2 day 1 and 15), G (800 mg/m2 day 1 and 15), and capecitabine (1,250 mg/m2/day days 1–28, without a break) and were randomized to receive either D at 25–30 mg/m2 day 1 and 15 (arm A: PDXG regimen) or E at 30 mg/m2 day 1 and 15 (arm B: PEXG regimen). Cycles were repeated every 28 days for a maximum of 6 months. The Fleming design was used to calculate the sample size on the probability of being PFS6. Assuming P0 = 40% and P1 = 60%, α = 0.05 and β = 0.10; the study was to enroll 52 patients per arm.


Between July 2005 and September 2008, 105 patients were enrolled, stratified by stage and randomized. Patients’ characteristics were (A/B) the following: median age 61/59, PS >70 92/88%, metastatic disease 66/65%. PFS6 was 58%, and median OS was 11 months in both arms. A partial response was observed in 60/37% of patients. Main per cycle G3-4 toxicity was the following: neutropenia 4/13%, thrombocytopenia 2/4%, anemia 4/4%, and fatigue 6/3%.


The inclusion of D instead of E yielded more objective response and less G3-4 neutropenia but did not improve PFS and OS. The present trial confirms the relevant impact on outcome of advanced PA of 4-drug regimens.


Capecitabine Chemotherapy Cisplatin Docetaxel Gemcitabine Pancreatic cancer 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Michele Reni
    • 1
  • Stefano Cereda
    • 1
  • Alessia Rognone
    • 1
  • Carmen Belli
    • 1
  • Michele Ghidini
    • 1
  • Simonetta Longoni
    • 1
  • Clara Fugazza
    • 1
  • Sara Rezzonico
    • 1
  • Paolo Passoni
    • 2
  • Najla Slim
    • 2
  • Giampaolo Balzano
    • 3
  • Roberto Nicoletti
    • 4
  • Stefano Cappio
    • 4
  • Claudio Doglioni
    • 5
  • Eugenio Villa
    • 1
  1. 1.Department of OncologySan Raffaele Scientific InstituteMilanItaly
  2. 2.Department of RadiotherapySan Raffaele Scientific InstituteMilanItaly
  3. 3.Department of SurgerySan Raffaele Scientific InstituteMilanItaly
  4. 4.Department of RadiologySan Raffaele Scientific InstituteMilanItaly
  5. 5.Department of PathologySan Raffaele Scientific InstituteMilanItaly

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