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Lim SH, Yun J, Lee MY, Kim HJ, Kim KH, Kim SH, Lee SC, Bae SB, Kim CK, Lee N, Lee KT, Park SK, Lee YN, Moon JH. Gemcitabine and Erlotinib with or without Oxaliplatin in Previously Untreated Advanced Pancreatic Cancer: A Randomized Phase II Trial. Yonsei Med J 2021; 62:671-678. [PMID: 34296544 PMCID: PMC8298866 DOI: 10.3349/ymj.2021.62.8.671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Erlotinib has been the only targeted agent to show significantly improved outcomes in pancreatic adenocarcinoma when combined with gemcitabine. We aimed to evaluate whether the addition of oxaliplatin to a combination gemcitabine/erlotinib treatment conferred a clinical benefit in patients with locally advanced unresectable or metastatic pancreatic cancer. MATERIALS AND METHODS Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned to receive GEMOX-T [gemcitabine 1000 mg/m² and oxaliplatin 50 mg/m² on day 1 (D1) and D8 plus erlotinib 100 mg daily for 3 weeks] or GT (gemcitabine 1000 mg/m² on D1 and D8 plus erlotinib 100 mg daily for 3 weeks). The primary endpoint was the overall response rate (ORR). RESULTS Between 2013 and 2016, 65 patients were assigned to a treatment group (33 in the GEMOX-T arm, 32 in the GT arm). The ORR was 18.2% [95% confidence interval (CI), 8.82-27.58] in the GEMOX-T arm and 6.2% (95% CI, 0.34-12.06) in the GT arm (p=0.051). The disease control rate was significantly superior in the GEMOX-T arm compared to the GT arm (72.7% vs. 43.8%, p=0.019). After a median follow-up of 19.7 months, the median progression-free survival (PFS) was 3.9 months for the GEMOX-T arm and 1.4 months for the GT arm (p=0.033). However, this did not translate to an improvement in overall survival. The most common grade 3 or higher hematologic adverse events were neutropenia (16.9%) and anemia (13.8%). CONCLUSION The addition of oxaliplatin to a first-line gemcitabine/erlotinib regimen demonstrated higher response rates and significantly improved PFS in patients with locally advanced or metastatic pancreatic cancer.
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Affiliation(s)
- Sung Hee Lim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jina Yun
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Min Young Lee
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Han Jo Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyoung Ha Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Se Hyung Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Chul Lee
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Byung Bae
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Chan Kyu Kim
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Namsu Lee
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyu Taek Lee
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seong Kyu Park
- Division of Hematology-Oncology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yun Nah Lee
- Division of Gastro-Enterology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong Ho Moon
- Division of Gastro-Enterology, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
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