title: Second-line chemotherapy with pemetrexed after gemcitabine failure in patients with advanced pancreatic cancer: a multicenter phase II trial.
abstract: BACKGROUND
  A standard second-line chemotherapy regimen has yet to be defined for patients with gemcitabine (Gem)-refractory advanced pancreatic cancer (PC).
  
  
  METHODS
  In this multicenter phase II trial, patients with unresectable or metastatic PC who had progressed on single-agent Gem or a Gem-containing regimen received pemetrexed 500 mg/m(2) as a 10-min infusion every 3 weeks until disease progression or occurrence of unacceptable toxicity. The primary end point was the 3-month survival rate.
  
  
  RESULTS
  A total of 192 treatment cycles were given to 52 patients. The overall response rate was 3.8% (two partial responses); 10 patients (19.2%) experienced stable disease, nine of them for >12 weeks. At least one CA 19-9 reduction > or =50% occurred in 12 patients (23.1%). The 3-month survival rate was 75% (95% confidence interval 63.2% to 86.8%), the median time to tumor progression was 7 weeks (range 1-62 weeks) and the median overall survival time was 20 weeks (range 1-84 weeks). Grade 3/4 hematological toxic effects included (percent of patients): neutropenia (17.3%), thrombocytopenia (5.8%) and anemia (3.8%). The most frequent non-hematological toxic effects were diarrhea, nausea and stomatitis/pharyngitis (23.1% each).
  
  
  CONCLUSIONS
  Pemetrexed is a safe treatment option with moderate activity in patients with advanced PC after failure of Gem.
authors.affiliation: Department of Internal Medicine III, University Hospital Grosshadern, Ludwigs-Maximilians University, Marchioninistrasse 15, D-81377 Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Boeck
authors.forename: K
authors.initials: K
authors.lastname: Weigang-Köhler
authors.forename: M
authors.initials: M
authors.lastname: Fuchs
authors.forename: E
authors.initials: E
authors.lastname: Kettner
authors.forename: D
authors.initials: D
authors.lastname: Quietzsch
authors.forename: J
authors.initials: J
authors.lastname: Trojan
authors.forename: O
authors.initials: O
authors.lastname: Stötzer
authors.forename: S
authors.initials: S
authors.lastname: Zeuzem
authors.forename: F
authors.initials: F
authors.lastname: Lordick
authors.forename: C-H
authors.initials: CH
authors.lastname: Köhne
authors.forename: H
authors.initials: H
authors.lastname: Kröning
authors.forename: T
authors.initials: T
authors.lastname: Steinmetz
authors.forename: H
authors.initials: H
authors.lastname: Depenbrock
authors.forename: V
authors.initials: V
authors.lastname: Heinemann
mesh_terms: D000328:Adult; D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005971:Glutamates / Q000009:adverse effects / Q000627:therapeutic use*; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D000068437:Pemetrexed; D015996:Survival Rate; D017211:Treatment Failure; D000093542:Gemcitabine
chemical_list: D018395:CA-19-9 Antigen; D005971:Glutamates; D000068437:Pemetrexed; D003841:Deoxycytidine; D006147:Guanine; D000093542:Gemcitabine