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Dose-intense PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine) in advanced pancreatic adenocarcinoma

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Abstract

Background

PEFG regimen (cisplatin and epirubicin 40 mg/m2 day 1, gemcitabine 600 mg/m2 days 1 and 8, 5-fluorouracil (FU) 200 mg/m2/day continuous infusion) significantly improved the outcome of patients with advanced pancreatic adenocarcinoma (PA) with respect to standard gemcitabine in a previous phase III trial. This regimen was subsequently modified in a dose-finding study by increasing dose intensity of cisplatin and epirubicin (both at 30 mg/m2 every 14 days) and of gemcitabine (at 800 mg/m2 every 14 days). Results of a consecutive series treated by dose-intense PEFG regimen are herewith reported.

Material and methods

Dose-intense PEFG was administered to chemotherapy-naive patients with stages III–IV PA, < 75 years, performance status (PS) > 50, till progressive disease or for a maximum of 6 months.

Results

Between January 2004 and June 2005, 49 (31 or 63% metastatic) patients, median age 62 years, median PS 80, were treated with dose-intense PEFG. Partial response and stable disease was observed in 24 (49%) and 16 (33%) patients, respectively; 31 patients were progression-free at 6 months (PFS-6 = 63%). Median survival was 10.5 months and 1-year overall survival (OS) was 48% (95% confidence interval: 33–61%). Main grade 3–4 toxicity was: neutropenia in 26% of patients, stomatitis and fatigue in 8%, anaemia, diarrhoea, nausea/vomit in 6%, febrile neutropenia and thrombocytopaenia in 4%, hand-foot syndrome in 2%.

Conclusion

When compared with 84 patients treated by classical PEFG at the same institution, dose-intense PEFG was not inferior in terms of PFS-6 (63 versus 57%), 1-year OS (48 versus 42%) and response rate (49 versus 49%); it allowed to increase dose intensity for gemcitabine by 32%, for cisplatin and epirubicin by 36% (FU reduced by 3%), to significantly reduce grade 3–4 hematological toxicity (neutropenia: 26 versus 86%; P < 0.00001; thrombocytopaenia: 4 versus 58%; P < 0.00001) and to reduce by one-third the number of outpatient accesses. The new PEFG schedule appears more suitable for clinical use and should be preferred as a basis for further development of therapeutic strategies against pancreatic cancer.

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Authors and Affiliations

  1. Department of Oncology, San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy

    M. Reni, S. Cereda, E. Bonetto, M. G. Viganò & P. Passoni

  2. Department of Surgery, San Raffaele Scientific Institute, Milan, Italy

    A. Zerbi, G. Balzano, C. Staudacher & V. Di Carlo

  3. Department of Radiology, San Raffaele Scientific Institute, Milan, Italy

    R. Nicoletti

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  1. M. Reni
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  2. S. Cereda
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Correspondence to M. Reni.

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Reni, M., Cereda, S., Bonetto, E. et al. Dose-intense PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine) in advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol 59, 361–367 (2007). https://doi.org/10.1007/s00280-006-0277-7

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  • DOI: https://doi.org/10.1007/s00280-006-0277-7

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