The Retrospective Study Of Gemcitabine-based Combinations As First-line Treatment For Advanced Pancreatic Cancer

Purposes:This retrospective study was performed to evaluate the activity and toxicity of gemcitabine-based combinations as first-line treatment in patients with locally advanced and metastatic pancreatic adenocarcinoma.Methods:Previously untreated metastatic and locally advanced pancreatic adenocarcinoma patients with PS0-2, who admitted in our center between August2008to March2012, were enrolled to this retrospective study. Patients received gemcitabine-based combinations as first-line treatment. Patients were assessed activity and safety profile after treatment.Results:Efficacy:all fifty patients were eligible to evaluate their therapeutic efficiency with median treatment time of3cycles (range:2-12). No complete response (CR) was achieved and partial response (PR) was observed in7patients (14%), stable disease (SD) in15(30%), and progressive disease (PD) in18(36%). Response rate (RR) and disease control rate (DCR) are14%and44%. Median6-month survival rate is24%,1-year is 22%and2-year2%. The median progression-free survival (PFS) was6.0months (95%CI,3.9to8.1months), and the median overall survival (OS) was9.5months (95%CI,7.7to11.3months). Gemcitabine monotherapy are compared with gemcitabine-based combinations in terms of PFS(4.3vs6.0months, P>0.05) and OS (6.2vs9.0months, P>0.05). PFS and OS in gemcitabine and GEMOX are4.3vs8.3months (P>0.05) and6.2vs9.8months (P>0.05), respectively. The median PFS in GEMOX plus targeted therapy is4.2months (95%CI,2.0to6.4months) with median OS unreached. The median OS of patients received second-line treatment after progression and patients who only got first-line treatment are9.5months (95%CI,3.9to15.1months) and11.7months (95%CI,6.7to16.7months)(P>0.05), respectively. Safety:The most common toxicity is hematologic. Grade Ⅲ/Ⅳ hematologic toxicities included neutropenia in14patients (28%), anemia in2patients (4%). Grade III/IV nausea and vomiting occurred in5patients and4patients, respectively, while grade I neuropathy in1(2%) patient.15patients had liver function damage.Conclusions:Gemcitabine-based combinations were effective and well-tolerated as first-line treatment for advanced pancreatic adenocarcinoma. We recommend those as first choice for advanced pancreatic patients with good PS. GEMOX combined with bevacizumab is also a choice for advanced pancreatic cancer.