PEFG (Cisplatin, Epirubicin, 5-Fluorouracil, Gemcitabine) Regimen as Second-Line Therapy in Patients With Progressive or Recurrent Pancreatic Cancer After Gemcitabine-Containing Chemotherapy

Reni, Michele; Cereda, Stefano; Mazza, Elena; Passoni, P.; Nicoletti, Roberto; Balzano, Gianpaolo; Zerbi, Alessandro; Arcidiacono, Paolo Giorgio; Staudacher, C.

doi:10.1097/coc.0b013e31814688f7

Cited by 21 publications

(11 citation statements)

References 27 publications

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“…The present study reports the findings on a single center cohort of patients who received second-line gemcitabine treatment for advanced-stage pancreatic adenocarcinoma. A survival of 3.6 months with second-line chemotherapy was observed, which is in agreement with previous published data (Table I) (7)(8)(9)(10)14,15,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Response to gemcitabine therapy at the first follow-up evaluation (at 2 months) impacted significantly the OS of the patients.…”

Section: Discussionsupporting

confidence: 81%

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

et al. 2017

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Abstract. There is a lack of prospective data about second-line treatments for metastatic pancreatic ductal adenocarcinoma patients. This is partially due to recent changes in first-line chemotherapy treatments. Despite this dearth of information, 50.0% of the patients who experience failure with first-line folinic acid, 5-fluorouracil, irinotecan and oxaliplatin (folfirinox) treatment are eligible for additional chemotherapy.

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Section: Discussionsupporting

confidence: 81%

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

et al. 2017

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“…Salvage treatment with a single agent, like pemetrexed [32], rubitecan [33], raltitrexed [34], epirubicin [35], capecitabine [36], docetaxel [37] and paclitaxel [38], yielded a median survival of 3.5–4.6 months and a 1-year OS of 0–15%. Apparently better results were reported with combination chemotherapy at time of salvage, with median survival times ranging between 5.2 and 8.3 months and 1-year OS between 12 and 32% [6,7,26,39,40,41,42,43]. In conclusion, our findings suggest that the MI combination is not recommended for clinical use in patients with gemcitabine-resistant pancreatic cancer.…”

Section: Discussionmentioning

confidence: 69%

“…Nine patients (45%) had a previous PFS >6 months. Previous treatment consisted of combination chemotherapy with doublets (fluoropyrimidine and gemcitabine; n = 3) [22,23] or 4 drugs (PEFG: cisplatin, epirubicin, fluorouracil, gemcitabine; PDXG or PEXG regimen: cisplatin, docetaxel or epirubicin, capecitabine, gemcitabine; n = 17) [24,25]; 7 patients also received a second-line chemotherapy with PEFG (n = 2) [26], PDXG (n = 1), PEXG (n = 1) [24], GEMOX (n = 1) [27], pemetrexed and irinotecan (n = 1) and gemcitabine (n = 1). Nine patients (45%) received further chemotherapy treatment after MI progression.…”

Section: Resultsmentioning

confidence: 99%

Salvage Therapy with Mitomycin and Ifosfamide in Patients with Gemcitabine-Resistant Metastatic Pancreatic Cancer: A Phase II Trial

Cereda¹,

Reni²,

Rognone³

et al. 2011

Chemotherapy

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Background: At the time of upfront treatment failure, over half of the patients with advanced pancreatic cancer are candidates for further treatment. Methods: Patients with metastatic gemcitabine-resistant pancreatic cancer were treated with mitomycin 8 mg/m² on day 1, ifosfamide 2,500 mg/m² and mesna 3,000 mg/m² on days 1–3 every 28 days until progressive disease. A positive responder was defined as a patient who was progression free at 6 months from trial enrolment. According to the Fleming design, a sample size of 34 patients was estimated assuming p0 = 0.05 and p1 = 0.20. Results: Between May 2006 and December 2007, 21 patients (median age 56 years; median Karnofsky performance score 80) were enrolled. One patient died before receiving any treatment. Eighteen patients interrupted chemotherapy due to progressive disease (n = 15), toxicity (n = 2) or refusal (n = 1). Grade >2 toxicity consisted of neutropenia in 80% of patients, thrombocytopenia and fatigue in 20% and anemia in 10%. Only 1 patient was progression free at 6 months (5%). One patient had a partial response (5%) and 2 patients had stable disease (10%). Median survival was 3.7 months. Conclusion: Based on the poor outcome observed and on the high level of grade 3–4 toxicity, the trial was prematurely stopped and the mitomycin and ifosfamide regimen was considered insufficiently active in gemcitabine-pretreated advanced pancreatic cancer.

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“…Previous retrospective studies of chemotherapy for second-line pancreatic cancer include the results for single agents such as docetaxel [14]; doublets such as irinotecan with docetaxel [15], IROX [16], FOLFOX [17], and FOLFIRI [18, 19]; triplets such as MDI [20]; and even the quadruplet regimen PEFG [21] (see Table 3). These studies have generally offered progression-free survival times of 8–16 weeks and survival of approximately 15–20 weeks.…”

Section: Discussionmentioning

confidence: 99%

The use of GTX as second-line and later chemotherapy for metastatic pancreatic cancer: a retrospective analysis

Dakik

Moskovic

Carlson

et al. 2011

Cancer Chemother Pharmacol

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Purpose There are limited data regarding the role of second-line treatment for metastatic pancreatic cancer (mPC) after the failure of initial chemotherapy. No data exist on the use of GTX after the failure of first-line therapy. Patients and methods We identified patients who were given GTX chemotherapy for a diagnosis of mPC after the failure of initial therapy. Demographic features, progression-free (PFS) and overall survival (OS), response to treatment, and toxicities were recorded. Results The 59 evaluable patients received a median of 2 prior therapies. Three had no prior gemcitabine. Median PS was 1. Median survival was 22 weeks; progression-free survival was 9.9 weeks. Survival did not correlate with the number of prior regimens but trended with PS. There were no radiologic responses; those with stable disease (n = 21) had a better survival than those with progression (n = 29) or unevaluable patients (n = 9). Median survival was 38.3, 15.0, and 7.4 weeks, respectively. Grade 3 and 4 toxicities included leucopenia (n = 14), anemia (n = 7), and thrombocytopenia (n = 6). Hospitalizations were required in 21 patients, for febrile neutropenia (n = 7), non-neutropenic infection (n = 3), pulmonary embolus (n = 2), anemia or failure to thrive (n = 9). A 75% drop or more in CA 19-9 correlated with improved survival. Conclusions GTX is an active regimen in patients previously treated with gemcitabine for mPC. Better performance status and >75% drop in pretreatment CA 19-9 were associated with longer survival. The number of prior regimens did not predict for survival duration.

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PEFG (Cisplatin, Epirubicin, 5-Fluorouracil, Gemcitabine) Regimen as Second-Line Therapy in Patients With Progressive or Recurrent Pancreatic Cancer After Gemcitabine-Containing Chemotherapy

Abstract: PEFG regimen in gemcitabine refractory pancreatic cancer had an acceptable toxicity profile and interesting activity, and may constitute a treatment option in this setting.

Cited by 21 publications

References 27 publications

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

Salvage Therapy with Mitomycin and Ifosfamide in Patients with Gemcitabine-Resistant Metastatic Pancreatic Cancer: A Phase II Trial

The use of GTX as second-line and later chemotherapy for metastatic pancreatic cancer: a retrospective analysis

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