Response to the combination of thalidomide and capecitabine as second-line therapy in pancreatic carcinoma after treatment and failure with gemcitabine

Abstract

14150 Background: A literature search shows only one published case report utilizing the combination of thalidomide and capecitabine as second-line therapy in adenocarcinoma of the pancreas. We report two patients with pancreatic carcinoma treated as second-line therapy with this combination. Methods: CASE #1: Fifty five-year-old female with metastatic pancreatic carcinoma demonstrated clear evidence of progression after 8 months of treatment with gemcitabine At this time, she was started on thalidomide 50 mg at bedtime every other night with capecitabine 1500 mg p.o. b.i.d. for two weeks with one week off. After eight weeks of this regimen, the patient had clinical response with a decrease in abdominal pain, improvement in performance status, and a decrease in her CA 19–9 from 1154 units/mL to 101 units/mL. With this treatment the patient was fully ambulatory and without symptoms for 7 months. CASE #2: The patient is 55-year-old male treated with adjuvant radiation therapy and chemotherapy after surgical resection of his adenocarcinoma of the pancreas. Eight months later, he developed hepatic metastasis and was treated with gemcitabine with progression of disease on that agent. Palliative treatment with capecitabine 1500 mg p.o. b.i.d. for two weeks and one week off was instituted with thalidomide 50 mg at bedtime every other day. After four months of this regimen, the patient had a clinical response with no abdominal pain and decrease in his CA 19–9 from 4647 units/mL to 55 units/mL. Ten months after initiation this regimen patient is asymptomatic, working full time and continues to take thalidomide and capecitabine. Conclusions: Response to second line therapy in adenocarcionoma of pancreas is rare. We are reporting two cases of second-line therapy of adenocarcinoma of the pancreas treated with the combination of thalidomide and capecitabine. Decline in CA 19–9, duration of response, and improvement in functional patient status were unexpected findings. Use of combination of capecitabine and thalidomide in the treatment of the pancreatic adenocarcinoma should be evaluated further in clinical trials. No significant financial relationships to disclose.