Abstract
Objective
We retrospectively compared the efficacy and toxicity of gemcitabine combination with capecitabine or erlotinib in unresectable pancreatic cancer to know whether the combination with cytotoxic and target agent has more benefit comparing to combination of cytotoxic agents.
Methods
Fifty-three patients with unresectable pancreatic cancer, treated with gemcitabine and capecitabine (GC) or gemcitabine and erlotinib (GE) as first line between October 2006 and July 2010, were reviewed. In GC group, patients were treated with gemcitabine 1,000 mg/m2 on days 1, 8, and capecitabine 1,300 mg/m2 bid was administered on days 1–14, repeated every 21 days. In GE group, gemcitabine was given at 1,000 mg/m2 I.V for 30 min on days 1,8,15, and erlotinib was taken orally at 100 mg through days 1–28, repeated every 28 days.
Results
Response rate was similar, 23.5 % in GE and 21.1 % in GC, but GC had better disease control rate with 73.7 % than GE with 52.9 %. GC also showed longer PFS and OS (5.37 and 14.43 months) than GE (2.63 and 6.23 months) (p = 0.032 for PFS and 0.002 for OS). In toxicity profiles, GC had more hematologic toxicities and GE had more non-hematologic toxicities.
Conclusions
The combination with cytotoxic agents seems to have better efficacy and clinical outcome than combination with cytotoxic agent and target agent. The new combination should be developed for the treatment for advanced pancreatic cancer.
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References
Berlin JD, Catalano P, Thomas JP et al (2002) Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 20(15):3270–3275
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(6):2403–2413
Cartwright TH, Cohn A, Varkey JA et al (2002) Phase II study of oral capecitabine in patients with advanced or metastatic pancreatic cancer. J Clin Oncol 20(1):160–164
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(33):5513–5518
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(24):3946–3952
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(16):2212–2217
Hess V, Salzberg M, Borner M et al (2003) Combining capecitabine and gemcitabine in patients with advanced pancreatic carcinoma: a phase I/II trial. J Clin Oncol 21(1):66–68
Jemal A, Siegel R, Ward E et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249
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(22):3617–3622
Louvet C, Labianca R, Hannel 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(15):3509–3516
Matano E, Taqliaferri P, Libroia A et al (2000) Gemcitabine combined with continuous infusion 5- fluorouracil in advanced and symptomatic pancreatic cancer: a clinical benefit-oriented phase II study. Br J Cancer 82(11):1772–1775
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):1960–1966
Oettle H, Richards D, Ramanathan RK et al (2005) A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann Oncol 16(10):1639–1645
Park BB, Park JO, Lee HR et al (2007) A phase II trial of gemcitabine plus capecitabine for patients with advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol 60(4):489–494
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(22):3605–3610
Rauch DP, Maurer CA, Aebi S et al (2001) Activity of gemcitabine and continuous infusion fluorouracil in advanced pancreatic cancer. Oncology 60(1):43–48
Ren Q, Kao V, Grem JL (1998) Cytotoxicity and DNA fragmentation associated with sequential gemcitabine and 5-fluoro-2’-deoxyuridine in HT-29 colon cancer cells. Clin Cancer Res 4(11):2811–2818
Schilsky RL, Bertucci D, Vogelzang NJ et al (2002) Dose-escalating study of capecitabine plus gemcitabine combination therapy in patients with advanced cancer. J Clin Oncol 20(2):582–587
Xie DR, Yang Q, Chen DL et al (2010) Gemcitabine-based cytotoxic doublets chemotherapy for advanced pancreatic cancer: updated subgroup meta-analyses of overall survival. Jpn J Clin Oncol 40(5):432–441
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Jeon, E.K., Won, HS., Ko, YH. et al. Comparison of the efficacy and the toxicity between gemcitabine with capecitabine (GC) and gemcitabine with erlotinib (GE) in unresectable pancreatic cancer. J Cancer Res Clin Oncol 138, 1625–1630 (2012). https://doi.org/10.1007/s00432-012-1234-y
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DOI: https://doi.org/10.1007/s00432-012-1234-y