Combination Chemotherapy in Advanced Pancreatic Cancer: Time to Raise the White Flag?

Abstract

Gemcitabine has been the standard palliative chemotherapy in advanced pancreatic cancer since 1997; this standard was established by a phase III trial that randomly assigned 126 symptomatic patients with advanced pancreatic cancer to either gemcitabine or fluorouracil (FU). 1 Treatment with gemcitabine versus FU was associated with improvements in 1-year survival (18% v 2%, respectively) and clinical benefit response (24% v 5%, respectively). Subsequently, thousands of patients have participated in large phaseIIItrialscomparinggemcitabinealonewithgemcitabineplus a second cytotoxic agent. 2-5 In the current issue, Herrmann et al 6 present another such study, comparing gemcitabine plus capecitabine with gemcitabine alone in advanced disease. The trial by Herrmann et al 6 is of high quality and was based on evidence from earlier phase studies that suggested the combination had sufficient activity to warrant further testing. 7,8 Similar to all prior studies