Maintenance Chemo vs CRT for Locally Advanced Pancreatic Cancer

There was no significant difference in overall survival between chemoradiotherapy and chemotherapy alone in patients with locally advanced pancreatic cancer with disease controlled after 4 months of induction chemotherapy, a study published in JAMA has shown.¹

Because the role of chemoradiotherapy is controversial in locally advanced pancreatic cancer, researchers sought to evaluate whether chemoradiotherapy improved survival of patients controlled after 4 months gemcitabine-based induction chemotherapy. As the efficacy of erlotinib in this treatment setting remains unknown, researchers also evaluated the effect of erlotinib on survival.

For the international, open-label, phase 3 trial, researchers enrolled 442 patients with locally advanced pancreatic cancer. Participants were randomly assigned to receive gemcitabine 1000 mg/m² intravenously weekly or gemcitabine plus erlotinib 100 mg/day orally. The 269 patients with progression-free disease after 4 months were then randomly assigned to undergo the same chemotherapy for 2 months or chemoradiotherapy consisting of capecitabine plus 54 Gy.

Results showed that median overall survival from the date of the first randomization was 16.5 months (95% CI, 14.5 – 18.5) with chemotherapy alone compared with 15.2 months (95% CI, 13.9 – 17.3) with chemoradiotherapy (HR, 1.03; 95% CI, 0.79 – 1.34; P = .83).

Further, researchers found that median overall survival from the date of first randomization was 13.6 months (95% CI, 12.3 – 15.3) for gemcitabine vs 11.9 months (95% CI, 10.4 – 13.5) for gemcitabine plus erlotinib (HR, 1.19; 95% CI, 0.97 – 1.45; P = .09).

Although there was no significant difference in median overall survival between chemoradiotherapy and chemotherapy alone, the study demonstrated that chemoradiotherapy was associated with decreased local progression (P = .03) and no increase in grade 3 to 4 toxicity, except for nausea.

Reference

1. Hammel P, Huguet F, van Laethem J-L, et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA. 2016;315(17):1844-1853.