Chemotherapy After Surgery Delays Pancreatic Cancer Recurrence

Additional treatment increased disease-free survival time by six months, study reports

TUESDAY, Jan. 16, 2007 (HealthDay News) -- Using chemotherapy after surgical removal of a pancreatic tumor may help people live disease-free a little bit longer.

German researchers report that people who took the chemotherapy drug gemcitabine following pancreatic cancer surgery lived disease-free an average of six months longer than those who had only the surgery. Their report is published in the Jan. 17 issue of the Journal of the American Medical Association.

"Pancreatic cancer is an extremely malignant tumor, and even if the disease is diagnosed at an early stage and the tumor can be completely [removed], the risk of relapse and early death remains high," explained the study's lead author, Dr. Helmut Oettle, an associate professor at the Charite School of Medicine in Berlin.

"Gemcitabine prolonged median disease-free survival significantly by more than six months -- 13.4 months [for the gemcitabine group] compared to 6.9 months after observation alone," Oettle said.

Surgery isn't an option for most people with pancreatic cancer. Only about one in five patients is considered a good surgical candidate. For those who can't have surgery, gemcitabine is currently the only standard chemotherapy drug in use, according to Dr. Al Benson, an oncology specialist at Northwestern University Feinberg School of Medicine in Chicago and the author of an accompanying editorial in the journal.

Researchers hoped that using gemcitabine after surgery would help destroy any remaining cancer cells.

"There is a presumption that microscopic tumor cells are present even after surgery that we can't currently detect," Benson said.

For the study, Oettle's team recruited 368 people from 88 cancer centers in Germany and Austria. All of the people had been recently diagnosed with pancreatic cancer, but none had metastatic cancer, which means the cancer was confined to the pancreas at the start of the study. Additionally, none of the study participants had been treated with chemotherapy or radiation before the study began.

All underwent surgical resection -- removal -- of the tumor. Then, half were treated with six cycles of gemcitabine every four weeks, and half received no additional treatment.

The average time before follow-up was 53 months. At the end of the study, 74 percent of the gemcitabine group and 92 percent of the control group had developed recurrent cancer.

The average time of disease-free survival -- meaning the length of time before the cancer returned -- was 13.4 months for the gemcitabine group compared to 6.9 months for the control group.

During the study period, however, there was no significant difference between the two groups in overall survival. The median survival for those in the gemcitabine group was 22.1 months, compared to 20.2 months for the control group.

But more people on gemcitabine lived disease-free longer: at three years 23.5 percent for the gemcitabine group, compared to 7.5 percent of the control group.

"The beneficial effect of gemcitabine on disease-free survival was significant, independent of the completeness of surgical resection, regional lymph node involvement or the size of the primary tumor," Oettle said. "Every patient with completely resected early pancreatic cancer should be offered adjuvant treatment after surgery, and gemcitabine is a well-tolerated, and probably the most effective, option to reduce the risk for disease recurrence."

"This study offers a glimmer of hope for at least some pancreatic cancer patients," said Benson, who added that much more research needs to be done to try to understand the biology of pancreatic cancer. "We view this gemcitabine study as a small step forward, and hope it will promote much more research."

Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La., added: "This is an important advance for a very dismal disease, and it will change the way we treat patients with resected cancer. It's not a home run, but it's an advance we'll be offering our patients, and it's a very well-tolerated drug."

Each year, more than 33,000 Americans are diagnosed with pancreatic cancer and more than 32,000 die from it, according to the American Cancer Society.

The biggest risk factors for developing this type of cancer include a history of tobacco use, obesity, diabetes, exposure to toxic chemicals and a family history of the disease, according to the cancer society.

More information

To learn more about pancreatic cancer and the available treatment options, visit the U.S. National Cancer Institute.

SOURCES: Helmut Oettle, M.D., associate professor, Charite School of Medicine, Berlin, Germany; Al Benson, M.D., professor of medicine, division of hematology/oncology, Northwestern University Feinberg School of Medicine, and associate director for clinical investigation, Robert H. Lurie Comprehensive Cancer Center, Chicago; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Health System, Baton Rouge, La.; Jan. 17, 2007, Journal of the American Medical Association
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