Definitive results of a phase II trial of cisplatin epirubicin, continuous-infusion fluorouracil, and gemcitabine in stage IV pancreatic adenocarcinoma

Purpose: To evaluate the efficacy and toxicity of a cisplatin, epirubicin, gemcitabine, and fluorouracil (PEF-G) schedule on stage IV pancreatic adeno carcinoma. Patients and Methods: Patients less than or equal to 70 years, with no prio r chemotherapy and with bidimensionally measurable stage IV pancreatic aden acarcinoma, Eastern Cooperative Oncology Group performance status less than or equal to 2, and adequate bone marrow, kidney, and liver function were e ligible for this trial. Eligibility criteria for clinical benefit assessmen t were pain with at least a daily analgesic consumption of two nonsteroidal anti-inflammatory drugs or Karnofsky performance status between 50 and 70. Treatment consisted of 40 mg/m(2) each of cisplatin and epirubicin day 1, gemcitabine 600 mg/m(2) on days 1 and 8 every 4 weeks, and fluorouracil 200 mg/m(2)/d as a protracted venous infusion. Results: Between April 1997 and April 1999, 49 patients from a single insti tution were eligible for the study. Altogether, 203 cycles (median, four cy cles) of PEF-G were delivered. The objective response rate was 58% in 43 as sessable patients and 51% in the intent-to-treat population. Fourteen patie nts had stable disease. Grade 3 or 4 World Health Organization neutropenia occurred in 51% of cycles, thrombocytopenia in 28%, anemia in 7%, stomatiti s in 5%, and diarrhea, and nausea, and vomiting in 2%. The median duration of response was 8.5 months. The median time to tumor progression was 7.5 mo nths. The median survival was 11 months in the assessable population and 10 months in the intent-to-treat population. Clinical benefit was achieved in 22 (78%) of 28 assessable patients. Conclusion: PEF-G is a well-tolerated and safe regimen; it obtained a very high rate of durable responses and deserves further evaluation in a phase I II trial. (C) 2001 by American Society of Clinical Oncology.