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Approximately 60% of patients with pancreatic cancer have metastatic disease at the time of diagnosis.1 Gemcitabine, which has been shown to improve overall survival (OS) and clinical response compared with 5-fluorouracil (5-FU), is standard treatment with a median survival of 6 months and a 1 year survival rate of only 20%.2 The addition of other drugs to gemcitabine to improve outcome has been generally unsuccessful with the exception of erlotinib, an oral human epidermal growth factor 1 receptor/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor. The combination of erlotinib with gemcitabine resulted in an improved 1 year survival compared with gemcitabine alone (23% vs 17%, p=0.023).3 Data from a phase III trial evaluating gemcitabine with capecitabine (GEM-CAP) showed an improvement in response and progression-free survival with GEM-CAP over single-agent gemcitabine, and pooling of these results with two other randomised controlled trials in a meta-analysis resulted in a survival advantage with GEM-CAP.4
At this year's American Society of Clinical Oncology annual meeting, the interim analysis from the randomised phase III PRODIGE 4/ACCORD 11 trial comparing FOLFIRINOX (5-FU/leucovorin, irinotecan and oxaliplatin) with gemcitabine as first-line treatment for fit patients with metastatic pancreatic adenocarcinoma was presented.5 These preliminary results were encouraging, with a significantly longer OS, progression-free survival and improved response rate associated with the experimental arm compared with gemcitabine alone. Although …
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