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Gemcitabine plus erlotinib followed by capecitabine versus capecitabine plus erlotinib followed by gemcitabine in advanced pancreatic cancer: final results of a randomised phase 3 trial of the ‘Arbeitsgemeinschaft Internistische Onkologie’ (AIO-PK0104)
  1. Volker Heinemann1,
  2. Ursula Vehling-Kaiser2,
  3. Dirk Waldschmidt3,
  4. Erika Kettner4,
  5. Angela Märten5,
  6. Cornelia Winkelmann6,
  7. Stefan Klein7,
  8. Georgi Kojouharoff8,
  9. Thomas C Gauler9,
  10. Ludwig Fischer von Weikersthal10,
  11. Michael R Clemens11,
  12. Michael Geissler12,
  13. Tim F Greten13,
  14. Susanna Hegewisch-Becker14,
  15. Oleg Rubanov15,
  16. Gerold Baake16,
  17. Thomas Höhler17,
  18. Yon D Ko18,
  19. Andreas Jung19,
  20. Sascha Neugebauer20,
  21. Stefan Boeck1
  1. 1Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
  2. 2Practice for Medical Oncology, Landshut, Germany
  3. 3Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
  4. 4Department of Hematology/Oncology, Klinikum Magdeburg, Magdeburg, Germany
  5. 5Department of Surgery, University of Heidelberg, Heidelberg, Germany
  6. 6Department of Internal Medicine, Krankenhaus Lutherstadt-Wittenberg, Lutherstadt-Wittenberg, Germany
  7. 7Department of Internal Medicine IV, Klinikum Bayreuth, Bayreuth, Germany
  8. 8Practice for Medical Oncology, Darmstadt, Germany
  9. 9Department of Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen, Essen, Germany
  10. 10Department of Oncology, Gesundheitszentrum St. Marien GmbH, Amberg, Germany
  11. 11Department of Internal Medicine I, Klinikum Trier, Trier, Germany
  12. 12Department of Gastroenterology and Oncology, Klinikum Esslingen, Klinikum Esslingen, Germany
  13. 13Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany
  14. 14Practice for Medical Oncology, Hamburg, Germany
  15. 15Practice for Medical Oncology, Hameln, Germany
  16. 16Practice for Medical Oncology, Pinneberg, Germany
  17. 17Department of Internal Medicine I, Prosper Hospital, Recklinghausen, Germany
  18. 18Department of Medical Oncology, Johanniter Krankenhaus, Bonn, Germany
  19. 19Department of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany
  20. 20WiSP Research Institute, Langenfeld, Germany
  1. Correspondence to Professor Volker Heinemann, Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians University of Munich, Marchioninistr. 15, D-81377 Munich, Germany; volker.heinemann{at}med.uni-muenchen.de

Abstract

Objective AIO-PK0104 investigated two treatment strategies in advanced pancreatic cancer (PC): a reference sequence of gemcitabine/erlotinib followed by 2nd-line capecitabine was compared with a reverse experimental sequence of capecitabine/erlotinib followed by gemcitabine.

Methods 281 patients with PC were randomly assigned to 1st-line treatment with either gemcitabine plus erlotinib or capecitabine plus erlotinib. In case of treatment failure (eg, disease progression or toxicity), patients were allocated to 2nd-line treatment with the comparator cytostatic drug without erlotinib. The primary study endpoint was time to treatment failure (TTF) after 1st- and 2nd-line therapy (TTF2; non-inferiority design). KRAS exon 2 mutations were analysed in archival tumour tissue from 173 of the randomised patients.

Results Of the 274 eligible patients, 43 had locally advanced and 231 had metastatic disease; 140 (51%) received 2nd-line chemotherapy. Median TTF2 was estimated with 4.2 months in both arms; median overall survival was 6.2 months with gemcitabine/erlotinib followed by capecitabine and 6.9 months with capecitabine/erlotinib followed by gemcitabine, respectively (HR 1.02, p=0.90). TTF for 1st-line therapy (TTF1) was significantly prolonged with gemcitabine/erlotinib compared to capecitabine/erlotinib (3.2 vs 2.2 months; HR 0.69, p=0.0034). Skin rash was associated with both TTF2 (rash grade 0/1/2–4:2.9/4.3/6.7 months, p<0.0001) and survival (3.4/7.0/9.6 months, p<0.0001). Each arm showed a safe and manageable toxicity profile during 1st- and 2nd-line therapy. A KRAS wild-type status (52/173 patients, 30%) was associated with an improved overall survival (HR 1.68, p=0.005).

Conclusion Both treatment strategies are feasible and demonstrated comparable efficacy; KRAS may serve as biomarker in patients with advanced PC treated with erlotinib.

Trial registration number This study was registered at ClinicalTrials.gov, number NCT00440167.

  • Erlotinib
  • capecitabine
  • gemcitabine
  • KRAS
  • pancreatic cancer
  • chemotherapy
  • cancer
  • chemotherapy
  • pancreatic cancer

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Footnotes

  • Previous presentation 46th ASCO Annual Meeting, 4–8 June, 2010, Chicago, IL and 35th ESMO Congress, 8–12 October, 2010, Milan, Italy.

  • Funding This work was supported by Hoffmann-La Roche, Germany.

  • Competing interests VH: Roche (consultant, honoraria for scientific presentations, research funding). UV-K: none. DW: none. EK: none. AM: none. CW: none. SK: none. GK: none. TCG: none. LFvW: none. MRC: Roche (honoraria for scientific presentations, research funding, travel grants). MG: none. TFG: none. SH-B: none. OR: none. GB: none. TH: none. YDK: none. AJ: none. SN: none. SB: Roche (honoraria for scientific presentations, research funding, travel grants).

  • Ethics approval This study was conducted with the approval of the ethics committee of the Ludwig-Maximilians University of Munich, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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