P-0103 Metronomic Capecitabine for Patients with Advanced Pancreatic Cancer

Abstract

IntroductionPancreatic cancer is the fourth leading cause of cancer deaths among men and women, being responsible for 6% of all cancer-related deaths. Gemcitabine based chemotherapy is a standard treatment for advanced pancreatic carcinoma. The prognosis for patients with pancreatic cancer remains extremely poor. The phase III United Kingdom National Cancer Research Institute GEMCAP trial, showed that treatment with the gemcitabine-capecitabine combination produced a significantly higher objective response rate and progression-free survival and was associated with a trend toward improved overall survival. Despite that, the prognosis for patients with pancreatic cancer remains extremely poor. We tried to improve the outcome for patients with advanced pancreatic cancer by antiangiogenic effects of metronomic capecitabine. MethodsIn this study we included patients diagnosed to have advanced pancreatic cancer who received systemic gemcitabine-based chemotherapy or chemoirradiation and had either partial response or at least stationary disease but were not amenable to surgical resection. Patients were given capecitabine daily at a dose of 500 mg twice daily continuously. Treatment was continued tell disease progression or unacceptable toxicity. Treatment started 3 weeks after the last cycle of chemotherapy. Patients were followed clinically monthly. Complete blood count, liver and kidney functions and tumor marker CA 19-9 were requested monthly. Imaging studies were requested every three months or upon clinical suspicion of disease progression. ResultsWe included twenty five patients. Patients had WHO performance status 0 or 1. Mean age of our patients was 49.2 years. There were 19 males and 6 females. All patients received Gemcitabine based systemic chemotherapy. Twenty two patients received Gemcitabine-carboplatin for 6 cycles and 3 patients received concomitant chemoirradiation. Seventeen patients had stationary disease and eight patients had partial response to primary treatment. Our patients tolerated treatment well. There was no grade 3/4 toxicity reported. One patient developed palmar-plantar erythema of grade two which resolved by stopping treatment for one week. Median time to progression was 6.7 months. There was a mean reduction for about 30% of the analgesics needed at enrollment. Seven patients survived beyond one year. One patient achieved partial response and was alive beyond one year. ConclusionThe use of metronomic doses of capecitabine in advanced pancreatic carcinoma was feasible and tolerable. There was mild prolongation in disease free survival. Longer follow-up and inclusion of a larger number of patients is recommended for further defining its impact on survival.