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Phase II Study of Gemcitabine, Cisplatin, and Infusional Fluorouracil in Advanced Pancreatic Cancer

B.F. El-Rayes, M.M. Zalupski, A.F. Shields, U. Vaishampayan, L.K. Heilbrun, V. Jain, V. Adsay, J. Day, P.A. Philip

From the Karmanos Cancer Institute, Wayne State University, Detroit; and University of Michigan, Ann Arbor, MI.

Address reprint requests to Philip A. Philip, MD, PhD, FRCP, Karmanos Cancer Institute, Wayne State University, 4100 John R St, Detroit, MI 48201; email: philipp{at}karmanos.org.

Purpose: This phase II study was undertaken to determine the efficacy of adding infusional fluorouracil (FU) to the chemotherapy doublet of gemcitabine and cisplatin in patients with advanced pancreatic cancer.

Patients and Methods: The eligibility criteria included histologically or cytologically confirmed adenocarcinoma of the pancreas that was either unresectable or metastatic. No prior gemcitabine therapy was allowed. Patients received a combination of gemcitabine 1,000 mg/m² intravenously (IV) on days 1, 8, and 15; cisplatin 50 mg/m² IV on days 1 and 15; and FU 175 mg/m²/d from days 1 to 15 by continuous IV infusion. Cycles were repeated every 28 days. Objective tumor response and toxicity were evaluated according to the World Health Organization criteria.

Results: A total of 47 patients (median age, 57 years; males, 59%) were enrolled. Sixteen patients had locally advanced (LA) disease, and 31 patients had metastatic disease. A total of 183 cycles of chemotherapy were administered. In patients with metastatic disease (n = 31), the probability of survival at 6 and 12 months was 66% and 34%, respectively. Objective partial response or stable disease was observed in 26% (90% confidence interval [CI], 0.14 to 0.41) and 61% (90% CI, 0.45 to 0.74) of patients, respectively. In patients with LA disease (n = 16), there were three partial responses (19%; 90 CI, 0.07 to 0.39). One patient in this group was successfully resected after FU-based radiotherapy. The most common grade 3 to 4 toxicities were neutropenia (60%), thrombocytopenia (42%), and anemia (26%). Thirteen patients were hospitalized for treatment-related complications.

Conclusion: The combination of gemcitabine, cisplatin, and infusional FU has significant activity in patients with advanced pancreatic cancer.

Supported in part by Cancer Center Support grant no. CA-22453 from the National Cancer Institute, Bethesda, MD, and by Eli Lilly Oncology, Indianapolis, IN.

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