Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 88; no. 4; pp. 837 - 844
• Main Authors: Esnaola, Nestor F., MD, Chaudhary, Uzair B., MD, O'Brien, Paul, MD, Garrett-Mayer, Elizabeth, PhD, Camp, E. Ramsay, MD, Thomas, Melanie B., MD, Cole, David J., MD, Montero, Alberto J., MD, Hoffman, Brenda J., MD, Romagnuolo, Joseph, MD, Orwat, Kelly P., MD, Marshall, David T., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-03-2014
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Capecitabine; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemoradiotherapy - mortality; CHEMOTHERAPY; COMPARATIVE EVALUATIONS; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Drug Administration Schedule; Female; Fluorouracil - administration & dosage; Fluorouracil - analogs & derivatives; Hematology, Oncology and Palliative Medicine; Humans; Induction Chemotherapy - adverse effects; Induction Chemotherapy - methods; Induction Chemotherapy - mortality; Male; Middle Aged; NEOPLASMS; Organoplatinum Compounds - administration & dosage; PANCREAS; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated - methods; SAFETY; SURGERY
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2013.12.030

Purpose To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.