Cancer Chemotherapy and Pharmacology

, Volume 69, Issue 2, pp 425–430 | Cite as

The use of GTX as second-line and later chemotherapy for metastatic pancreatic cancer: a retrospective analysis

  • Hassan K. Dakik
  • Daniel J. Moskovic
  • Peter J. Carlson
  • Eric P. Tamm
  • Wei Qiao
  • Robert A. Wolff
  • James L. Abbruzzese
  • David R. FogelmanEmail author
Original Article



There are limited data regarding the role of second-line treatment for metastatic pancreatic cancer (mPC) after the failure of initial chemotherapy. No data exist on the use of GTX after the failure of first-line therapy.

Patients and methods

We identified patients who were given GTX chemotherapy for a diagnosis of mPC after the failure of initial therapy. Demographic features, progression-free (PFS) and overall survival (OS), response to treatment, and toxicities were recorded.


The 59 evaluable patients received a median of 2 prior therapies. Three had no prior gemcitabine. Median PS was 1. Median survival was 22 weeks; progression-free survival was 9.9 weeks. Survival did not correlate with the number of prior regimens but trended with PS. There were no radiologic responses; those with stable disease (n = 21) had a better survival than those with progression (n = 29) or unevaluable patients (n = 9). Median survival was 38.3, 15.0, and 7.4 weeks, respectively. Grade 3 and 4 toxicities included leucopenia (n = 14), anemia (n = 7), and thrombocytopenia (n = 6). Hospitalizations were required in 21 patients, for febrile neutropenia (n = 7), non-neutropenic infection (n = 3), pulmonary embolus (n = 2), anemia or failure to thrive (n = 9). A 75% drop or more in CA 19-9 correlated with improved survival.


GTX is an active regimen in patients previously treated with gemcitabine for mPC. Better performance status and >75% drop in pretreatment CA 19-9 were associated with longer survival. The number of prior regimens did not predict for survival duration.


Pancreatic cancer Chemotherapy Adenocarcinoma Survival 



This research is supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672. Dr. Wolff received the Research Funding from Eli Lilly.


  1. 1.
    Jermal A, Siegel R, Ward E et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249CrossRefGoogle Scholar
  2. 2.
    Burris HA, Moore MJ, Anderson 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 15:2403–2413PubMedGoogle Scholar
  3. 3.
    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 27:5513–5518PubMedCrossRefGoogle Scholar
  4. 4.
    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 24:3946–3952PubMedCrossRefGoogle Scholar
  5. 5.
    Herrmann R, Bodoky G, Ruhstaller T et al (2007) Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol 25:2212–2217PubMedCrossRefGoogle Scholar
  6. 6.
    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 27:3778–3785PubMedCrossRefGoogle Scholar
  7. 7.
    Stathopoulos GP, Syrigos K, Aravantinos G et al (2006) A multicenter phase III trial comparing irinotecan-gemcitabine (IG) with gemcitabine (G) monotherapy as first-line treatment in patients with locally advanced or metastatic pancreatic cancer. Br J Cancer 95(5):587–592PubMedCrossRefGoogle Scholar
  8. 8.
    Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23(15):3509–3516Google Scholar
  9. 9.
    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(15):1960–1966Google Scholar
  10. 10.
    Conroy T, Desseigne F, Ychou M et al (2010) Randomized phase III trial comparing FOLFIRINOX (F: 5FU/Leucovorin [LV], irinotecan [I], and oxaliplatin [O]) versus gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial. J Clin Oncol 28:15s (suppl; abstr 4010)Google Scholar
  11. 11.
    Fine RL, Fogelman DR, Schreibman SM et al (2008) The gemcitabine, docetaxel, and capecitabine (GTX) regimen for metastatic pancreatic cancer: a retrospective analysis. Cancer Chemother Pharmacol 61:167–175PubMedCrossRefGoogle Scholar
  12. 12.
    Tanaka M, Javle M, Dong X et al (2010) Gemcitabine metabolic and transporter gene polymorphisms are associated with drug toxicity and efficacy in patients with locally advanced pancreatic cancer. Cancer 116(22):5325–5335PubMedCrossRefGoogle Scholar
  13. 13.
    Mancuso A, Sacchetta S, Saletti PC et al (2010) Clinical and molecular determinants of survival in pancreatic cancer patients treated with second-line chemotherapy: results of an Italian/Swiss multicenter survey. Anticancer Res 30(10):4289–4295PubMedGoogle Scholar
  14. 14.
    Saif MW, Syrigos K, Penney R, Kaley K (2010) Docetaxel as second line therapy in patients with advanced pancreatic cancer: a retrospective study. Anticancer Res 30(7):2905–2909PubMedGoogle Scholar
  15. 15.
    Ko AH, Dito E, Schillinger B, Venook AP, Bergsland EK, Tempero MA (2008) Excess toxicity associated with docetaxel and irinotecan in patients with metastatic, gemcitabine-refractory pancreatic cancer: results of a phase II study. Cancer Invest 26(1):47–52PubMedCrossRefGoogle Scholar
  16. 16.
    Oh S, Kim H, Kim T et al (2010) Pilot study of irinotecan/oxaliplatin (IROX) combination chemotherapy for patients with gemcitabine- and fluorouracil-refractory pancreatic cancer. Invest New Drugs 28(3):343–349PubMedCrossRefGoogle Scholar
  17. 17.
    Gebbia V, Maiello E, Giuliani F et al (2007) Second-line chemotherapy in advanced pancreatic carcinoma: a multicenter survey of the Gruppo Oncologico Italia Meridionale on the activity and safety of the FOLFOX4 regimen in clinical practice. Ann Oncol 18(6):vi124–27Google Scholar
  18. 18.
    Cereda S, Reni M, Rognone A et al (2010) XELIRI or FOLFIRI as salvage therapy in advanced pancreatic cancer. Anticancer Res 30(11):4785–4790PubMedGoogle Scholar
  19. 19.
    Yoo C, Hwang JY, Kim JE, Kim TW, Lee JS, Park DH, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ, Kim SC, Lee JL (2009) A randomized phase II study of modified FOLFIRI.3 vs modified FOLFOX as second line therapy in patients with gemcitabine refractory advanced pancreatic cancer. Br J Cancer 101:1658–1663Google Scholar
  20. 20.
    Reni M, Panucci MG, Passoni P et al (2004) Salvage chemotherapy with mitomycin, docetaxel, and irinotecan (MDI regimen) in metastatic pancreatic cancer: a phase I and II trial. Cancer Invest 22(5):688–696PubMedCrossRefGoogle Scholar
  21. 21.
    Reni M, Cereda S, Mazza E et al (2008) PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine) regimen as second-line therapy in patients with progressive or recurrent pancreatic cancer after gemcitabine-containing therapy. Am J Clin Oncol 31(2):145–150PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hassan K. Dakik
    • 1
  • Daniel J. Moskovic
    • 2
  • Peter J. Carlson
    • 2
  • Eric P. Tamm
    • 3
  • Wei Qiao
    • 3
  • Robert A. Wolff
    • 3
  • James L. Abbruzzese
    • 3
  • David R. Fogelman
    • 3
    Email author
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.The University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations