title: The addition of erlotinib to gemcitabine and cisplatin does not appear to improve median survival in metastatic pancreatic cancer.
abstract: Metastatic pancreatic cancer carries a poor prognosis, with median survival on the order of several months. There is evidence that combining gemcitabine with either erlotinib or cisplatin may be superior to single agent gemcitabine in patients with good performance (PS 0-1). We retrospectively compared outcomes of patients treated with either the three drug regimen of gemcitabine, cisplatin, and erlotinib (GCE) or the doublet of gemcitabine and cisplatin (GC) in order to assess the potential benefit of erlotinib. We also evaluated the role of erlotinib among smokers and non-smokers. We retrospectively analyzed 145 patients who presented between 2006 and 2009 with previously untreated metastatic pancreatic cancer initially treated at the M.D. Anderson cancer center with either GC or GCE. Information on tumor characteristics and overall survival time (OS) was collected by medical record review. Kaplan-Meier curves were used to estimate OS. Log rank tests were used to compare OS between groups. The Cox proportional hazards regression model was used to evaluate the ability of patient prognostic variables or treatment group to predict OS. A total of 71 patients were treated with GC, while 74 were treated with GCE. Cox analyses found no significant difference in overall survival (median 5.5 vs. 8.0 months, respectively, p-value=0.1). Small sampling numbers may have contributed to this result. One year survival was 23 % in the GCE group and 13 % in the GC group. Patients with poor performance status (PS=2-3) had worse survival as compared to patients with better performance status (PS=0-1, p=0.001). As in earlier studies, patients treated with more lines of therapy tended to have better survival (p <0.0001), and CA19-9 was found to be a significant predictor for OS (p=0.001). No statistical evidence of a survival difference was found between smokers and non-smokers in both treatment groups (p=0.72). In conclusion, though there was a trend towards improved survival with the addition of erlotinib to gemcitabine and cisplatin, this does not reach statistical significance.
authors: M.D. Anderson Cancer Center, 1515 Holcombe Blvd Unit 426, Houston, TX, 77030, USA, MAKhalil1@mdanderson.org.
authors: Mohamed A
authors: MA
authors: Khalil
authors: Wei
authors: W
authors: Qiao
authors: Peter
authors: P
authors: Carlson
authors: Binsah
authors: B
authors: George
authors: Milind
authors: M
authors: Javle
authors: Michael
authors: M
authors: Overman
authors: Gauri
authors: G
authors: Varadhachary
authors: Robert A
authors: RA
authors: Wolff
authors: James L
authors: JL
authors: Abbruzzese
authors: David R
authors: DR
authors: Fogelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D011799:Quinazolines / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; D002945:Cisplatin; D000093542:Gemcitabine
references: Mol Carcinog. 2012 Jan;51(1):40-52
references: 22162230
references: Asia Pac J Clin Oncol. 2010 Jun;6(2):98-105
references: 20565421
references: J Cancer Res Clin Oncol. 2013 Apr;139(4):681-9
references: 23315099
references: N Engl J Med. 2011 May 12;364(19):1817-25
references: 21561347
references: Cancer Chemother Pharmacol. 2012 Dec;70(6):875-81
references: 23053263
references: Ann Oncol. 2012 Jul;23(7):1713-22
references: 22241899
references: Int J Radiat Oncol Biol Phys. 2013 May 1;86(1):96-101
references: 23265573
references: J Clin Oncol. 2005 May 20;23(15):3509-16
references: 15908661
references: Ann Surg Oncol. 2013 Jul;20(7):2188-96
references: 23247983
references: CA Cancer J Clin. 2013 Jan;63(1):11-30
references: 23335087
references: Med Oncol. 2012 Dec;29(4):2831-7
references: 22392197
references: Langenbecks Arch Surg. 2008 Jul;393(4):535-45
references: 18193270
references: Invest New Drugs. 2012 Dec;30(6):2371-6
references: 22302349
references: J Thorac Oncol. 2009 Jan;4(1):22-9
references: 19096302
references: J Gastroenterol Hepatol. 2008 Aug;23(8 Pt 1):1292-7
references: 18700899
references: Clin Cancer Res. 2006 Apr 1;12(7 Pt 1):2166-71
references: 16609030
references: Cancer Res. 2009 Apr 15;69(8):3681-8
references: 19351817
references: J Clin Oncol. 2007 May 20;25(15):1960-6
references: 17452677
references: Cancer Chemother Pharmacol. 2012 Feb;69(2):415-24
references: 21800112
references: Cancer. 2008 Oct 15;113(8):2046-52
references: 18756532
references: Ann Oncol. 2012 Jul;23(7):1880-8
references: 22104574
references: Neoplasia. 2012 Dec;14(12):1102-14
references: 23308043
references: Clin Lung Cancer. 2006 May;7(6):389-94
references: 16800964
references: Cancer Chemother Pharmacol. 2012 Jan;69(1):115-23
references: 21626049
references: J Clin Oncol. 2006 Aug 20;24(24):3946-52
references: 16921047
references: Am J Epidemiol. 2009 Aug 15;170(4):403-13
references: 19561064
references: Ann Oncol. 2007 Oct;18(10):1652-9
references: 17660491
references: Oncology. 2010;78(3-4):249-58
references: 20523085
references: BMC Cancer. 2008 Mar 28;8:82
references: 18373843
references: J Clin Oncol. 1997 Jun;15(6):2403-13
references: 9196156
references: Cancer Chemother Pharmacol. 2012 Feb;69(2):425-30
references: 21850466
references: Int J Clin Oncol. 2013 Oct;18(5):839-46
references: 22996141
references: J Thorac Oncol. 2010 Oct;5(10):1609-15
references: 20808255