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Clinical Analysis of Gemcitabine Plus Capecitabine as First-Line Treatment Administered on41Cases of Advanced Pancreatic Cancer

Author: WangXiang
Tutor: BaiChunMei
School: Beijing Union Medical College
Course: Internal Medicine
Keywords: pancreatic cancer gemcitabine capecitabine chemotherapy
CLC: R735.9
Type: Master's thesis
Year: 2012
Downloads: 13
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Abstract

Objective:To evaluate the efficacy and toxicity of the combination chemotherapy of gemcitabine with capecitabine(GEMCAP) on the patients of pancreatic cancer as first-line treatment and analyze the influence of various factors on the efficacy of chemotherapy.Methods:Forty-one advanced pancreatic cancer patients who received GEMCAP regimen as first-line chemotherapy between January2005and September2012were analyzed retrospectively.In the analysis of the influence of different factors on efficacy,six clinical variables were chosen on the basis of previously published clinical trials.The variables were divided into two categories:stage(locally advanced/metastatic disease), ECOG performance status(0-1/2-3),location of primary tumor(head-neck/body-tail),serum carbohydrate antigen19-9(CA19-9) level (norma-1/abnormal),age(<55/>55years),smoking.The toxicities associated with chemotherapy were also analyzed. Spearman correlation and partial correlation analysis、COX proportional hazard regression model、Kaplan-Meier method、 Log-rank test were applied in the statistical analysis.Results:Among the forty-one patients who received GEMCAP regimen as first-line chemotherapy,thirty-nine subjects were assessable as complete response in0cases(0.0%),partial response in5cases(12.8%),stable disease in23cases(59.0%) and progressive disease in11cases(28.2%);objective response rate and disease control rate were12.8%and71.8%;clinical response in23cases,clinical response rate was56.1%;the median progression-free survival(PFS) was5.0months(95%CI,4.63to5.37months),the median overall survival(OS) was10.0months(95%CI,6.24to13.7months),and the median1-year survival rate was38.7%.In the subgroup analysis,the median PFS of locally advanced group was longer than that of metastatic group,showing statistic difference(5.5months:4.0months,P=0.048),while OS showing no significant difference(10.0months:8.0months,P=0.114).The patients with a good performance status(ECOG0-1) earned more clinical benefit compared with the patients with a bad performance status(ECOG2-3),Spearman correlation analysis indicated that a P value of0.011between the ECOG performance status and the concurrent efficacy,while the partial correlation showed a P value of0.132with factors such as stage、age were standardized,disease progression RR was3.445(95%CI,1.24-9.57),and median PFS and OS in patients with a good performance(ECOG0-1) were statistically significantly longer respectively. Location of primary tumor、age、smoking history demonstrated no correlation with progression and survival time.The group who had normal baseline CA19-9levels was associated with a trend toward better OS compared with the group who had increased baseline CA19-9levels(P=0.094),but should be demonstrated by further research;the median baseline CA19-9level for patients who had increased CA19-9level before treatment manifested no correlation with progression and survival time;patients with a fall of>25%in the baseline CA19-9level after chemotherapy achieved a longer median OS and disease progression RR was14.69(95%CI,2.92-73.90).The most common adverse effects included hematologic toxicities、digestive tract complaints、drug eruptions、drug fever、hand-foot syndrome,mainly classified as grade1-2.Conclusions: 1、GEMC AP regimen is not only effective but also of acceptable and manageable toxicity for advanced pancreatic cancer patients.2、The median PFS of locally advanced pancreatic cancer patients was longer than that of metastatic group with statistic difference, while OS showing no significant difference.3、The patients with a good performance status(ECOG0-1) earned more clinical benefit compared with the patients with a bad performance status(ECOG2-3), the concurrent efficacy、PFS and OS of the former one were obviously increased than the latter one.4、The baseline CA19-9levels before treatment maybe make influence on prognosis,but should be demonstrated by further research; patients with a fall of>25%in the baseline CA19-9level after chemotherapy achieved a longer median OS.5、Location of primary tumor、age、smoking history demonstrated no correlation with progression and survival time.

Clinical Analysis of Gemcitabine Plus Capecitabine as First-Line Treatment Administered on41Cases of Advanced Pancreatic Cancer

Abstract

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