Abstract
Purpose : To determine the maximum tolerated dose (MTD) and dose-limiting toxicities of gemcitabine, paclitaxel, and concurrent radiation for pancreatic cancer. Methods and Materials : Twenty patients with locally unresectable pancreatic cancer were studied. The initial dose level was gemcitabine 75 mg/m 2 and paclitaxel 40 mg/m 2 weekly for 6 weeks. Concurrent radiation to 50.4 Gy was delivered in 1.8 Gy fractions. The radiation fields included the primary tumor, plus the regional peripancreatic, celiac, and porta hepatis lymph nodes. Results : Dose-limiting toxicities of diarrhea, dehydration, nausea, and anorexia occurred in 3 of 3 patients at the second dose level of gemcitabine, 150 mg/m 2/week. An intermediate dose level of gemcitabine, 110 mg/m 2/week, was added, but gastrointestinal toxicity and pulmonary pneumonitis were encountered. The MTD therefore was gemcitabine 75 mg/m 2/week with paclitaxel 40 mg/m 2/week and concurrent radiation. Two of 11 patients treated at the MTD had Grade 3/4 toxicity. Four of 10 assessable patients treated at the MTD responded (40%), including one pathologic complete response. Conclusion : The maximum tolerated dosage of gemcitabine is 75 mg/m 2/week with paclitaxel 40 mg/m 2/week and conventional 50.4 Gy radiation fields. A Phase II Radiation Therapy Oncology Group study is under way.
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