According to a study published in the Annals of Oncology, combination chemotherapy with pemetrexed (Alimta®) and gemcitabine (Gemzar®) for treatment of advanced pancreatic cancer does not improve survival. As well, this combination increases toxicity more than treatment with Gemzar alone.
The pancreas, a gland located in the abdomen, produces juices that help digest foods and the hormones glucagon and insulin, which help regulate blood sugar levels. Pancreatic cancer is the fourth leading cause of cancer deaths in the US. Unfortunately, pancreatic cancer is not curable in most cases and is operable in only some cases. Current treatment options for pancreatic cancer include surgery, radiation, and chemotherapy. Although single-agent chemotherapy with Gemzar remains the standard treatment for pancreatic cancer, research has increasingly focused on the development of combination chemotherapy regimens.
In order to determine whether treatment of advanced pancreatic cancer with the combination of Alimta and Gemzar results in better survival than treatment with Gemzar alone, researchers in Germany conducted a phase III clinical trial comparing the two treatment regimens. The study enrolled 565 patients with locally advanced or metastatic pancreatic cancer. None of the patients were candidates for surgery, and none had received chemotherapy previously. Half the patients were treated with the combination of Alimta and Gemzar, and half were treated with Gemzar alone.
The addition of Alimta to Gemzar did not improve overall survival, nor did it delay cancer progression. Median survival was nearly equal for both groups: 6.2 months for patients treated with Alimta and Gemzar and 6.3 months for those treated with Gemzar alone. Toxic effects of treatment were more common among patients treated with Alimta and Gemzar; patients receiving the combination therapy were more likely to experience low white blood cell levels, low platelet levels, low red blood cell levels, and fatigue.
The researchers conclude that the addition of Alimta to Gemzar does not improve survival for patients with advanced pancreatic cancer, and that single-agent Gemzar remains the standard of care.
Reference: Oettle H, Richards D, Ramanathan RK et al. A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. *Annals of Oncology.*2005;16:1639-1645.
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