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Sandra and Edward Meyer Cancer Center

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Addition of capecitabine to adjuvant chemotherapy extends survival in pancreatic cancer

Friday, June 3, 2016

The addition of capecitabine to standard adjuvant gemcitabine chemotherapy significantly extended survival of patients with resected pancreatic ductal adenocarcinoma, according to results of a randomized phase 3 trial presented at the ASCO Annual Meeting. Allyson Ocean, M.D., was invited by HemOnc Today, to provide her perspective on the results. Read the full article here.

Gastrointestinal oncologist Allyson Ocean of the Meyer Cancer CenterAllyson Ocean, M.D. These results are very encouraging for patients with pancreatic cancer who are able to have surgery. Even patients with poor prognostic factors — such as poorly differentiated disease, nodal involvement, locally advanced disease or incomplete resection — demonstrated a survival benefit.

It is important to remember that most patients don’t even get to surgery, so our efforts need to be concentrated on early detection and identifying which patients should have surgery. However, it is very encouraging that we have a new standard of care for those who do undergo surgery.

The median OS benefit is very modest. Is 2 months meaningful in a disease that takes your live pretty quickly? I don’t know, but I do think it is meaningful that we saw such an improvement in 5-year survival. This combination also was very safe and didn’t affect quality of life, so now it can serve as a backbone to which we can add other agents.

We also must consider where this comes into play with radiation. Previously, for patients who had surgery and then proceeded to adjuvant treatment, I chose to treat them with chemotherapy first — typically gemcitabine alone — followed by radiation if their disease was localized after a few months based on Radiation Therapy Oncology Group data. This trial changes things, as we now have a combination chemotherapy that improves OS, but it was done without any radiation. This is a key unanswered question. There are trials looking at other regimens with and without radiation that hopefully will provide some answers.

A big-picture look at these data shows us that 30% of patients are living 5 years, but 70% are not. We need to work with the clinical trialists to develop scientifically driven, patient-centric clinical trials to improve outcomes. The numbers from this trial certainly are one step forward, but they are very far away from a cure. We should applaud these data, which are important and are practice changing, but we also have to keep in mind that we have a long way to go.

    New Standard of Care

    In an interview with The ASCO PostDr. Ocean also noted: “Now we have a regimen of drugs that we have been using separately or in combination in various settings, and this treatment almost doubled the five-year survival rate. Nearly 30 percent of patients were alive at five years, and that’s remarkable in this disease. It was also well tolerated, and patients had good quality of life.”

    “We can’t ignore these data,” Dr. Ocean commented. “I think that we now need to concentrate more on early detection of pancreatic cancer. Very few patients with this disease are even able to have surgery.”