07.10.2013

Xeloda treatment for pancreatic cancer quotes

Licence fees: A licence fee will be charged for any media (low or high resolution) used in your project. Background: Chemotherapy for advanced adenocarcinoma of the pancreas may have severe toxicities including neuropathy, leukopenia, and bleeding risks. Methods: In a retrospective study, 79 patients with adenocarcinoma of the pancreas, TNM stage 3 or 4, or recurrent disease, received 2 or more cycles of monthly chemotherapy.
Conclusion: This monthly chemotherapy is well tolerated and provides an overall survival comparable to other intensive regimens.
An alternative therapy has been developed that greatly improves the tolerability of chemotherapy, reduces the time burden on patients, and provides better tolerance of the treatment-induced side effects, and yet maintains duration of overall survival (OS).
Capecitabine is an oral prodrug of 5-FU that is designed to exploit the differences in activating enzyme (thymidine phosphorylase) activity between tumor and normal tissue that results in a threefold increase in the concentration of the active metabolite in the tumor cell.6 It was generally recognized that the useful chemotherapy drugs available are gemcitabine, 5-FU, oxaliplatin, bevacizumab, nab-paclitaxel, and recently the experimental nanosomal irinotecan MM-398. With this background, we developed and piloted an alternative therapy, fixed-dose-rate infusion of gemcitabine with escalating-dose capecitabine, which has the potential to greatly improve tolerability and reduce the time burden on patients.
Our adult patients with stage IIB to IV pancreatic cancer includ-ed 54 patients with newly diagnosed advanced disease and 25 patients with prior chemotherapy and relapsed disease. Treatment-related toxicities were graded using the National Cancer Institute Common Toxicity Criteria, version 3 (2003). Retrospective analysis was conducted after the Midwestern Institutional Review Board confirmed that the data collection was IRB-exempt, with all data collected being de-identified prior to analysis and reporting. Monthly follow-up visits involved physical examination and standard laboratory tests including complete blood count (CBC), chemistries with liver function tests, and tumor markers. The primary end points of this retrospective study were evidence of tumor response, survival, time to progression, and the preva-lence and grade of treatment-related toxicities.
Seventy-nine patients received therapy for stage IIB-III, recurrent disease, or stage IV pancreatic cancer (Table 2). All patients analyzed for survival received at least 2 cycles of capecitabine unless severe toxicity was experienced in the initial cycle. Safety and Tolerability Treatment-related AEs associated with this regimen included transient leukopenia generally lasting less than a week (Table 5). Sixty-four patients had no nausea or vomiting, 68 had no stomatitis, and 48 had no hand-foot syndrome. Cholangitis and sepsis occurred in patients who had high-degree obstruction of the biliary ducts, occurring universally when leukopenia was absent.
This study thus included 5 patients whose survival was longer than 2 SD above the mean of the other patients, suggesting they belonged to a subgroup, the basis of which will be studied in the future. The chemotherapy regimen of fixed-infusion-rate gemcitabine-and escalting-dose capecitabine offers a well-tolerated regimen for patients utilizing a convenient monthly chemotherapy. We are optimistic that genomic analysis of patients may provide a means to prospectively identify patients with pancreatic cancer whose biological subtype suggests the potential for prolonged survival.


Conroy T, Desseigne F, Ychou M, et al., FOLFIRINOX versus gemcitabine for metastatic pancreatic carcinoma.
Fifty-four patients had no prior chemo-therapy, while 25 patients had progressed after chemo-therapy. With few drugs available, the opportunities for development of combination chemotherapy are limited and cures are unlikely. We sought to examine whether this regimen could provide equivalent duration of OS as seen with other contemporary first-line regimens with less toxicity.
As such, this study complied with the International Ethical Guidelines for Biomedical Research In-volving Human Subjects, Good Clinical Practice guidelines, the Declaration of Helsinki, and local laws. Two patients who had previously received chemotherapy were lost to follow-up after 1 cycle of therapy and are not included in the results. There was no statistically significant difference in these survival curves by the log rank test. There was universal alopecia, as well as 3 instances of grade 3 stomatitis, 2 instances of grade 3 hand-foot syndrome, and 1 instance of grade 3 leukopenia lasting longer than 7 days, but on no occasion was scheduled chemotherapy delayed due to toxicity. This provides a significant increased quality of life for patients who need to receive chemotherapy.
Levin, MD, is chief of Medical Oncology at the Midwestern Regional Medical Center, Zion, IL. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. Phase II trial of a 24-hour infusion of gemcitabine in previously untreated patients with advanced pancreatic adenocarcinoma. Fixed dose-rate gem-citabine infusion as first-line treatment for advanced-stage carcinoma of the pancreas and biliary tree. Fixed dose-rate gem-citabine infusion as first-line treatment for advanced-stage carcinoma of the pancreas and biliary tree: series of 106 consecutive patients. Modulation of gem-citabine and oxaliplatin chemotherapy in advanced pancreatic cancer according to CIRS. Phase II study of fixed dose rate gemcitabine with cisplatin for metastatic adenocarcinoma of the pancreas J Clin Oncol. Bevacizumab combined with gemcitabine and capecitabine for advanced pancreatic cancer: a phase II study. Atoms are represented as spheres and are colour-coded: carbon (yellow), hydrogen (white), oxygen (red), nitrogen (blue) and fluorine (green). A retrospective case retrieval was used to analyze tumor response, OS, and treatment-related adverse events (AEs). Capecitabine dosage was increased to the highest dose tolerated with less than grade 3 toxicity.


Eighteen patients in this series had stage IIB-III cancer while 61 patients had stage IV disease. Twelve patients had prior gemcitabine-containing therapy, often with radiotherapy, and their median survival was 15.2 months. It provides comparable survival relative to more toxic contemporary regimens in patients and markedly prolonged survival in a subgroup of patients. After escalation, capecitabine was stopped before 14 days if unusual toxicity was occurring.
We treated them from February 2008 to November 2013 at the Midwestern Regional Medical Center in Zion, Illinois.
Frail patients received decreased dosage in the initial cycle, but escalation in the second cycle to customary doses. The time to progression was measured from the first cycle until radiological evidence of more than 25% increase in the product of cross diameters of a measurable tumor site. The third patient had massive liver metastases with disease progression during the first cycle. This group included 1 patient whose response to the gemcitabine-capecitabine phase was 34.3 months, a pro-longed survival 3 SD above the mean for the group. Patients with stage III disease received 2-5 cycles of chemotherapy preceding radiotherapy when radiotherapy was planned. Prolonged fixed-dose-rate infusions were developed with the knowledge that phosphorylation of gemcitabine into the active gemcitabine tri-phosphate is catalyzed by deoxycytidine kinase, an enzyme that is saturated by 30 minutes. To minimize and control toxicities, each patient was instructed in supportive care, antidiarrhea care, and the particular steps needed for minimizing hand-foot syndrome.
Of the 25 patients with relapsed disease, 4 had progressed after more than 1 chemotherapy regimen and 7 had had prior radiotherapy. Median survival of patients with stage III disease is delineated in Table 3, and Table 4 lists survival according to subgroups. The fourth patient apparently tolerated therapy well, but decided not to return for further chemotherapy for personal reasons. Chemo-therapy for nonresectable stage III or stage IV disease was continued if response was ongoing or improving, and was stopped when progressive disease was evident on radiological studies. These drugs closely resemble a substance, or metabolite, that is essential for a cell's normal biochemical reactions.



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