title: An Italian study on treatment trends and outcomes of patients with stage III pancreatic adenocarcinoma in the gemcitabine era: is it time to change?
abstract: A series of 650 patients treated between 1997 and 2007 at 10 Italian centers was analyzed to assess treatment trends and efficacy in stage III pancreatic adenocarcinoma. Data on patient characteristics, treatment and outcomes were collected. The inclusion criteria were pathological diagnosis of stage III pancreatic adenocarcinoma; age more than 18 years, Eastern Cooperative Oncology Group performance status less than 3, and no past therapy. Most patients (95%) received up-front chemotherapy, which mainly consisted of gemcitabine alone (N=323), gemcitabine-based four-drug combinations (N=107), gemcitabine-platinum compound doublets (N=87), or intra-arterial gemcitabine-free triplets (N=57). The use of gemcitabine-platinum compound doublets increased over time (1997-2001: 2%; 2002-2007: 21%) whereas an inverse trend was observed for gemcitabine (71-61%). No overall survival (OS) difference was observed between patients enrolled in clinical trials and those not enrolled. The median and 1-year OS were 9.5 months and 35.5% for patients treated with gemcitabine; 8.9 months and 36.8% for those treated with gemcitabine-free intra-arterial triplets; 13.3 months and 55.8% for those treated with gemcitabine-platinating agent doublets; and 16.2 months and 62.6% for those treated with gemcitabine-based four-drug combinations. Moreover, the median and 1-year OS were 12.7 months and 51.4% in patients who underwent planned consolidation chemoradiation, and 8.4 months and 30.4% in patients who did not. The use of a strategy consisting of a gemcitabine-platinating agent containing chemotherapy followed by consolidation chemoradiation has been increasing over time and may represent a suitable choice in the therapeutic management of stage III pancreatic adenocarcinoma.
authors.affiliation: Department of Oncology, San Raffaele Scientific Institute, via Olgettina 60, Milan, Italy. reni.michele@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.forename: Nora
authors.initials: N
authors.lastname: Sartori
authors.forename: Andrea
authors.initials: A
authors.lastname: Mambrini
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Passardi
authors.forename: Michele
authors.initials: M
authors.lastname: Milella
authors.forename: Stefano
authors.initials: S
authors.lastname: Cereda
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Tronconi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.forename: Stefano
authors.initials: S
authors.lastname: Cordio
authors.forename: Lara Maria
authors.initials: LM
authors.lastname: Pasetto
authors.forename: Alessia
authors.initials: A
authors.lastname: Rognone
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004358:Drug Therapy / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine