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Gemcitabine Not Superior for Resected Pancreatic Cancer

Overall survival not improved with gemcitabine versus fluorouracil plus folinic acid

TUESDAY, Sept. 7 (HealthDay News) -- For patients who undergo complete resection of pancreatic cancer, treatment with gemcitabine does not result in improved overall survival compared to treatment with fluorouracil plus folinic acid, though it may lead to fewer adverse events, according to a study in the Sept. 8 issue of the Journal of the American Medical Association.

In the European Study Group for Pancreatic Cancer (ESPAC)-3 trial, John P. Neoptolemos, M.D., of the University of Liverpool in the United Kingdom, and colleagues randomized 1,088 patients with pancreatic ductal adenocarcinoma who had undergone cancer resection to fluorouracil plus folinic acid or gemcitabine for six months, with patients undergoing at least two years of follow-up.

After a median of 34.2 months of follow-up after 753 deaths, the investigators found that median survival was 23.0 months for patients treated with fluorouracil plus folinic acid and 23.6 months for those treated with gemcitabine (P = .39). In terms of secondary outcome measures, 14 percent of patients treated with fluorouracil plus folinic acid experienced 97 treatment-related serious adverse events, while 7.5 percent of patients treated with gemcitabine had 52 events (P < .001). Progression-free survival and global quality-of-life scores did not differ significantly between the two groups.

"In conclusion, gemcitabine did not result in improved overall survival compared with fluorouracil plus folinic acid in patients with resected pancreatic cancer. As a logical progression from these data we have designed the ESPAC-4 trial, currently in progress, to compare combination chemotherapy with gemcitabine plus capecitabine, an orally active fluoropyrimidine, with gemcitabine alone," the authors write.

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