Abstract
Carcinomas of the exocrine pancreas respond poorly to most chemotherapy regimens. Recently continuous infusional 5-fluorouracil (200 mg m-(2)day-1) with 3 weekly cisplatin (60 mg m-2) and epirubicin (50 mg m-2) (the ECF regimen) has proven to be an active regimen in gastric and breast cancer and consequently worthy of further study in pancreatic cancer. Thirty-five patients were treated with the ECF regimen as above, of whom 29 were evaluable for response and 32 were evaluable for toxicity. The mean age was 59 years (range 37-75). Sixteen patients had locally advanced disease at presentation and 19 had metastases. Objective tumour responses were documented in five (17.3%) patients who achieved a partial response; in 18 (62%) patients there were no change and six (20.7%) patients progressed on therapy. Patients with either stable disease or partial response had a significantly improved overall survival (median = 253 days) compared with patients who progressed (median = 170 days; P = 0.01). Grade 3/4 (WHO) toxicity (all cycles) included alopecia in 18 (56%) patients, nausea/vomiting in eight (25%) stomatitis in three (9%) and diarrhoea in seven (22%) patients, with rhinorrhoea and excessive lacrimation in one patient each. Neutropenic sepsis occurred in 13 cycles in ten patients, and there was one toxic death due to sepsis. There were eight other episodes of non-neutropenic sepsis requiring hospital admission. Fourteen patients (40%) experienced complications with their Hickman lines, including thrombotic episodes (six patients) or their line falling out (five patients). ECF can prolong survival in patients with locally advanced or metastatic pancreatic cancer who demonstrate a response or stabilisation of their disease. However, this is associated with considerable toxicity.
Highlights
All patients entered into this study had histologically or cytologically confirmed adenocarcinoma of the pancreas
The partial response rate in this *study (17.3%) remains low compared with the response rates observed for gastro-oesophageal (71%) (Findlay et al, 1994) and breast cancer (84%) (Jones et al, 1994)
The response rate to ECF in pancreatic cancer is only marginally better than the responses reported with FAM or SMF I (14%) (Oster et al, 1986), 5-FU plus BCNU (10%) (Kovach et al, 1974) or 5-FU plus mitomycin C (10%) (Buroker et al, 1979), or continuous infusional 5-FU with cisplatin (16%) (Rothman et al, 1991), and is less than that observed for a 5 day infusion of 5-FU with a single cisplatin dose (26%) (Rougier et al, 1993)
Summary
The primary objective of the study was to evaluate the ECF regimen in pancreatic cancer, to assess the response rate, toxicity and patient survival, in view of the activity of this regimen in gastro-oesophageal and breast cancers
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