A randomized, multicenter, phase III study of gemcitabine combined with capecitabine versus gemcitabine alone as first-line chemotherapy for advanced pancreatic cancer in South Korea

Abstract

Background: This phase III trial compared the efficacy and safety of gemcitabine plus capecitabine (GemCap) versus single-agent gemcitabine (Gem) in advanced pancreatic cancer as first-line chemotherapy.

Methods: A total of 214 advanced pancreatic cancer patients were enrolled from 16 hospitals in South Korea between 2007 and 2011. Patients were randomly assigned to receive GemCap (oral capecitabine 1660 mg/m plus Gem 1000 mg/m by 30-minute intravenous infusion weekly for 3 weeks followed by a 1-week break every 4 weeks) or Gem (by 30-minute intravenous infusion weekly for 3 weeks every 4 weeks).

Results: Median overall survival (OS) time, the primary end point, was 10.3 and 7.5 months in the GemCap and Gem arms, respectively (P = 0.06). Progression-free survival was 6.2 and 5.3 months in the GemCap and Gem arms, respectively (P = 0.08). GemCap significantly improved overall response rate compared with Gem alone (43.7% vs 17.6%; P = 0.001). Overall frequency of grade 3 or 4 toxicities was similar in each group. Neutropenia was the most frequent grade 3 or 4 toxicity in both groups.

Conclusion: GemCap failed to improve OS at a statistically significant level compared to Gem treatment. This study showed a trend toward improved OS compared to Gem alone. GemCap and Gem both exhibited similar safety profiles.

Figure 1

Study population assigned to treatment from 16 hospitals. For the statistical analysis, we finally selected 214 patients with pancreatic cancer who received GemCap chemotherapy or Gem chemotherapy alone. Gem = gemcitabine, GemCap = gemcitabine plus capecitabine.

Figure 2

Kaplan–Meier overall survival curves and progression-free survival curves in pancreatic cancer patients. A, Median overall survival (OS) time, the primary end point, was 10.3 and 7.5 months in the GemCap and Gem arm, respectively (P = 0.06). B, Progression-free survival (PFS) was 6.2 and 5.3 months in the GemCap and Gem arm, respectively (P = 0.08). Gem = gemcitabine, GemCap = gemcitabine plus capecitabine.

Figure 3

Kaplan–Meier overall survival curves and progression-free survival curves in patients according to performance status. Subanalysis in patients with good performance status did not show a significant prolongation of median OS time and PFS time in the GemCap arm compared with Gem arm. Gem = gemcitabine, GemCap = gemcitabine plus capecitabine, OS = overall survival, PFS = progression free survival.