Healthcare Professionals
Chemotherapy
Although systemic chemotherapy is commonly used, its benefits must be carefully evaluated because of the toxicities associated with available agents. There have been many studies of single-agent and combination chemotherapy regimens in patients with metastatic disease however: few have shown improvements in survival or clinical benefit. The most commonly used agent for chemotherapy is gemcitabine. In a study by Burris et. al., it was found that gemcitabine reduced symptoms and improved the overall survival as compared to 5-FU.13 Although the response rate was 5.4% for gemcitabine and 0% for 5-FU, there was a statistically significant improvement in survival among patients who received gemcitabine. Table 1
Despite intensive examination of various doses and schedules of single-agent 5-FU, response rates have rarely exceeded 20%, and no consistent effect on disease-related symptoms and survival has been demonstrated.14,15
Table 1. Treatment outcomes with gemcitabine versus 5-FU in patients with advanced pancreatic cancer.
| |
Gemcitabine
(n=63) |
5-FU
(n=36) |
p value |
Clinical benefit
Clinical benefit response(%) |
23.8 |
4.8 |
0.0022 |
Objective tumour response
Partial response (PR)
Stable disease (SD)
Progressive disease |
3/56 (5.4%)
22/56(39.3%)
31/56(55.4%) |
0/57
11/57(19.3%)
46/57(80.7%) |
Ns |
Time to tumour progression |
Log rank test, p=0.0002 |
Median (months) |
2.33 |
0.92 |
Discontinued due to progession(%) |
61.5 |
79.4 |
Survival |
Overall survival (OS) |
Log rank test; p=0.0025 |
Median (months) |
5.65 |
4.41 |
6-month survival (%) |
46 |
31 |
1-year survival (%) |
18 |
2 |
Progression-free survival (PFS) |
6-months PFS (%) |
22 |
5 |
1-year PFS (%) |
9 |
5 |
ns = not significant |
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