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Optimal treatment of metastatic pancreatic cancer
  1. David Cunningham,
  2. Irene Chong
  1. The Royal Marsden Hospital, Sutton, Surrey, UK
  1. Correspondence to Professor David Cunningham, Professor of Cancer Medicine, The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK; david.cunningham{at}rmh.nhs.uk

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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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