Adjuvant interferon-based chemoradiation followed by gemcitabine for resected pancreatic adenocarcinoma: A single-lnstitution phase II study
ABSTRACT This is a phase II, single-center, single-arm study of patients with resectable adenocarcinoma of the pancreas who were treated with adjuvant interferon-based chemoradiation followed by gemcitabine. The primary end point was 2-year overall survival, with secondary endpoints being 2-year disease-free survival, and the frequency of grade 3 or 4 toxicity.
From April 2002 to September 2005, 53 patients with adenocarcinoma of the pancreas underwent curative resection at a single institution, and subsequently received interferon- and gemcitabine-based adjuvant therapy consisting of external-beam irradiation at a dose of 5040 cGy (25 fractions per 5 weeks) and simultaneous 3-drug chemotherapy consisting of (1) continuous infusion 5-fluorouracil (175 mg/m2); (2) weekly intravenous bolus cisplatin (25 mg/m2); and (3) interferon-alpha (3 million units subcutaneously 3 times per week) during the 6 weeks of radiation. This was followed by two 4-week courses of weekly intravenous infusion of gemcitabine (1000 mg/m2, 3 of 4 weeks).
Median follow-up is 38 months. Seventy-seven percent of patients had node-positive disease. Sixteen patients (30%) failed to complete adjuvant therapy, due to disease progression (7 patients), toxicity (7 patients), and consent withdrawal (2 patients). No patients completed planned therapy without dose modification. Median overall survival was 25 months (confidence interval [CI] = 21.5-48.5 months). Actuarial overall survival for the 1-, 2- and 3-year periods were 75% (CI = 61-85%), 56% (CI = 41-69%), and 41% (26-55%), respectively.
This phase II trial demonstrated increased patient survival compared with historical controls, and equivalent survival compared with the regimen combining interferon-alpha with 5-fluorouracil-based chemoradiation. Despite these encouraging results, significant concerns regarding dose- and treatment-limiting toxicities remain.
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- "First clinical results are expected for 2009. ACOSOG and the group of Linehan et al. confirmed in phase II trials the results from the Virginia Mason Clinic to a certain extent [7,8]. These excellent results could be ascribed to the several synergistic effects between the combined substances. "
ABSTRACT: The 5-year survival of patients with resected pancreatic adenocarcinoma is still unsatisfying. The ESPAC-1 and the CONKO 001 trial proofed that adjuvant chemotherapy improves 5-year survival significantly from approximately 14% to 21%. In parallel, investigators from the Virginia Mason Clinic reported a 5-year survival rate of 55% in a phase II trial evaluating a combination of adjuvant chemotherapy, immunotherapy and external beam radiation (CapRI-scheme). Two other groups confirmed in phase II trials these results to a certain extent. However, these groups reported severe gastrointestinal toxicity (up to 93% grade 3 or 4 toxicity). In a randomized controlled phase III trial, called CapRI, 110 patients were enrolled from 2004 to 2007 in Germany and Italy to check for reproducibility. Interestingly, much less gastrointestinal toxicity was observed. However, dose-reduction due to haematological side effects had to be performed in nearly all patients. First clinical results are expected for the end of 2009. CapRI-2 is an open, controlled, prospective, randomized, multicentre phase II trial with three parallel arms. A de-escalation of the CapRI-scheme will be tested in two different modifications. Patients in study arm A will be treated as outpatients with the complete CapRI-scheme consisting of cisplatin, Interferon alpha-2b and external beam radiation and three cycles of 5-fluorouracil continuous infusion. In study arm B the first de-escalation will be realised by omitting cisplatin. Next, patients in study arm C will additionally not receive external beam radiation. A total of 135 patients with pathologically confirmed R0 or R1 resected pancreatic adenocarcinoma are planned to be enrolled. Primary endpoint is the comparison of the treatment groups with respect to six-month event-free-survival. An event is defined as grade 3 or grade 4 toxicity, objective tumour recurrence, or death. The aim of this clinical trial is to evaluate de-escalation of the CapRI-scheme. It is hypothesised that removal of cisplatin and radiotherapy will have no significant effect or only a minor impact on the clinical response but result in substantially lower toxicity. Current Controlled Trials ISRCTN79802092.BMC Cancer 02/2009; 9(1):160. DOI:10.1186/1471-2407-9-160 · 3.32 Impact Factor
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ABSTRACT: There is an urgent need to monitor the condition of fluid-filled taped (FFT) cables. The dissolved-gas analysis (DGA) technique that has been successfully applied to power transformers holds great potential for the preventive maintenance of FFT cables. However, before this emerging technique can be properly applied to cables, a suitable fluid sampling and subsequent gas analysis method had to be developed, including the generation of both laboratory and field data to aid in data interpretation. Data on gas saturation levels in various cable fluids have been presented. This paper describes a novel method developed specifically for FFT cables and discusses field results so obtained. The type, distribution and concentration of gases from fluid alone and paper alone under electrical stress has been presented, including the differences between normal and not-so-normal cable systems as demonstrated by DGA. The concept of wet tensile strength has been introduced to the cable industry and it holds promise to serve as a cable aging indicator. DGA can successfully identify problem cable systems. Further work is in progress to refine the DGA technique and determine the remaining life of taped cablesIEEE Transactions on Power Delivery 02/1995; DOI:10.1109/61.368415 · 1.66 Impact Factor
- Annals of surgery 08/2008; 248(2):152-3. DOI:10.1097/SLA.0b013e3181820d35 · 7.19 Impact Factor