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Fixed dose-rate gemcitabine infusion as first-line treatment for advanced-stage carcinoma of the pancreas and biliary tree

Authors :
Alain Gelibter
Serena Di Cosimo
Giuseppe Maria Ettorre
Diana Giannarelli
M. Pellicciotta
Paolo Carlini
Paola Malaguti
Enzo Maria Ruggeri
Michele Milella
Edmondo Terzoli
Francesco Cognetti
Emilio Bria
Fabio Carboni
Source :
Cancer. 104(6)
Publication Year :
2005

Abstract

BACKGROUND Gemcitabine infusion at the fixed dose rate of 10 mg/m2 per minute (FDR-gemcitabine) has pharmacokinetic advantages and may result in improved therapeutic efficacy. METHODS Between April 2002 and September 2003, 40 patients with advanced-stage pancreatic adenocarcinoma (PDAC; n = 27) or biliary tree carcinoma (BTC; n = 13) were treated with weekly FDR-gemcitabine (1000 mg/m2). The primary end point was the response rate. The secondary end points were progression-free and overall survival (PFS and OS), tumor marker response, and clinical benefit response (CBR). RESULTS The overall response rate (ORR) on an intent-to-treat basis was 15% (95% confidence interval [95% CI], 4–26%). A positive CBR was obtained in 14 of 29 (48%) patients. Seventeen of 25 (68%) patients had a reduction in carbohydrate antigen 19-9 (CA 19-9) of > 25%. The median time to treatment failure and the median PFS were 17 weeks (95% CI, 13–22 weeks) and 19 weeks (95% CI, 15–23 weeks), respectively. The median OS was 40 weeks (95% CI, 36–45 weeks) and the 1-year actuarial survival rate was 25.8%. Multivariate analysis showed that a performance status score of 0–1 at study entry and locally advanced disease were the only independent predictors of longer PFS and OS, whereas a reduction in CA 19-9 serum levels > 75% was an independent predictor of longer PFS, but had no impact on OS. Toxicity was mild with Grade 3–4 neutropenia (according to the National Cancer Institute-Common Toxicity Criteria [version 2.0]) in 18 of 427 treatment weeks (4.2%), and Grade 3 anemia and thrombocytopenia in 6 of 427 treatment weeks (1.4%) and 9 of 427 treatment weeks (2.1%), respectively, and asymptomatic Grade 3–4 transaminase elevation in 21 of 427 treatment weeks (4.9%). CONCLUSIONS FDR-gemcitabine at the weekly dose of 1000 mg/m2 demonstrated promising activity, despite negligible toxicity, in patients with advanced-stage PDAC and BTC. Cancer 2005. © 2005 American Cancer Society.

Details

ISSN :
0008543X
Volume :
104
Issue :
6
Database :
OpenAIRE
Journal :
Cancer
Accession number :
edsair.doi.dedup.....59163e219f919b3f81924b0e307b963b