Gemcitabine and Erlotinib with or without Oxaliplatin in Previously Untreated Advanced Pancreatic Cancer: A Randomized Phase II Trial.

Abstract

PURPOSE:

Erlotinib has been the only targeted agent to show significantly improved outcomes in pancreatic adenocarcinoma when combined with gemcitabine. We aimed to evaluate whether the addition of oxaliplatin to a combination gemcitabine/erlotinib treatment conferred a clinical benefit in patients with locally advanced unresectable or metastatic pancreatic cancer.

MATERIALS AND METHODS:

Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned to receive GEMOX-T [gemcitabine 1000 mg/m² and oxaliplatin 50 mg/m² on day 1 (D1) and D8 plus erlotinib 100 mg daily for 3 weeks] or GT (gemcitabine 1000 mg/m² on D1 and D8 plus erlotinib 100 mg daily for 3 weeks). The primary endpoint was the overall response rate (ORR).

RESULTS:

Between 2013 and 2016, 65 patients were assigned to a treatment group (33 in the GEMOX-T arm, 32 in the GT arm). The ORR was 18.2% [95% confidence interval (CI), 8.82-27.58] in the GEMOX-T arm and 6.2% (95% CI, 0.34-12.06) in the GT arm (p=0.051). The disease control rate was significantly superior in the GEMOX-T arm compared to the GT arm (72.7% vs. 43.8%, p=0.019). After a median follow-up of 19.7 months, the median progression-free survival (PFS) was 3.9 months for the GEMOX-T arm and 1.4 months for the GT arm (p=0.033). However, this did not translate to an improvement in overall survival. The most common grade 3 or higher hematologic adverse events were neutropenia (16.9%) and anemia (13.8%).

CONCLUSION:

The addition of oxaliplatin to a first-line gemcitabine/erlotinib regimen demonstrated higher response rates and significantly improved PFS in patients with locally advanced or metastatic pancreatic cancer.

• Authors: Sung Hee Lim, Jina Yun, Min Young Lee, Han Jo Kim, Kyoung Ha Kim, Se Hyung Kim, Sang Chul Lee, Sang Byung Bae, Chan Kyu Kim, Namsu Lee, Kyu Taek Lee, Seong Kyu Park, Yun Nah Lee, Jong Ho Moon
• Journal: Yonsei medical journal (Yonsei Med J) Vol. 62 Issue 8 Pg. 671-678 (Aug 2021) ISSN: 1976-2437 [Electronic] Korea (South)
• PMID: 34296544 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial)
• Copyright: © Copyright: Yonsei University College of Medicine 2021.

Chemical References

• Oxaliplatin
• Deoxycytidine
• Erlotinib Hydrochloride
• Gemcitabine

Topics

• Adenocarcinoma (drug therapy)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Deoxycytidine (analogs & derivatives)
• Erlotinib Hydrochloride (adverse effects)
• Humans
• Oxaliplatin (therapeutic use)
• Pancreatic Neoplasms (drug therapy)
• Treatment Outcome
• Gemcitabine