Phase II evaluation of continuous-infusion 5-fluorouracil, leucovorin, mitomycin-C, and oral dipyridamole in advanced measurable pancreatic cancer - A North Central Cancer Treatment Group Trial

At present there remains a need for more effective systemic therapy in adva nced pancreatic cancer. Some studies have suggested that infusional chemoth erapy schedules and biomodulation of 5-fluorouracil (5-FU) may improve the therapeutic outcome in advanced colon cancer. One such regimen that uses co ntinuous infusion 5-FU, weekly leucovorin, daily dipyridamole, and intermit tent mitomycin-C has activity in both colon and unresectable pancreatic car cinoma. The intent of this trial was to test the effectiveness of this four -drug regimen in advanced pancreatic cancer. Patients received 5-FU 200 mg/ m(2) daily by continuous infusion, leucovorin 30 mg/m(2) IV weekly, mitomyc in-C 10 mg/m(2) day 1,and dipyridamole 75 mg orally four times daily for 5 weeks. After a 1-week break, treatment cycles were repeated every 6, weeks. Eligibility included biopsy-proven advanced measurable pancreatic cancer, Eastern Cooperative Oncology Group performance status 0 and 2, and no prior systemic chemotherapy. Of 46 evaluable patients, 9 partial responses and 1 complete tumor response were seen, for an overall response rate of 22% (95 % confidence interval 11-36%). The median survival in the group of 50 patie nts registered to this trial was 4.6 months, with a range of 0.33 to 40.2 m onths. Toxicity was manageable, with the most common toxicities (greater th an or equal to grade III National Cancer Institute Common Toxicity Criteria ) being anorexia (13%), stomatitis (17%), and hand-fool syndrome (13%). Of note, little severe hematologic toxicity and no significant headaches were reported. Although some patients did respond, the therapeutic results are n ot encouraging enough to take this regimen to phase III testing.