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New chemo combination 'should be standard pancreatic cancer treatment'

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A combination of two chemotherapy drugs should be the new standard treatment for pancreatic cancer after surgery to remove a tumour, according to UK researchers.

They said a combination of gemcitabine and capecitabine should replace the standard treatment of giving patients gemcitabine alone following surgery.

“This is one of the biggest ever breakthroughs prolonging survival for pancreatic cancer patients”

John Neoptolemos

The recommendation is based on a study that found 29% of patients given the combination lived for at least five years, compared with 16% given gemcitabine alone.

The Cancer Research UK-funded study suggests that the adoption of the treatment plan could double the number of patients who survive their disease for at least five years.

ESPAC-4 was a multicentre, open label, randomised phase 3 trial set up in 2008 to address the poor pancreatic cancer survival rates.

It involved 732 patients in hospitals across the UK, German, Sweden and France. Around half of the participants received gemcitabine and the other half received the combination.

There was no significant difference in side effects between the patients on the standard treatment and the combination treatment, said the researchers.

“We urgently needs new ways to treat and manage the disease”

Peter Johnson

Side effects included a drop in blood cells causing an increased risk of infection, bleeding or bruising problems, tiredness or shortness of breath, sore mouth, diarrhoea, feeling sick or being sick, sore hands and feet, flu like symptoms.

The results were first presented at the American Society of Clinical Oncology (ASCO) in June 2016, but have now been peer-reviewed and published today in The Lancet.

Trial lead Professor John Neoptolemos, from the University of Liverpool, said: “This is one of the biggest ever breakthroughs prolonging survival for pancreatic cancer patients.

“When this combination becomes the new standard of care, it will give many patients living with the disease valuable months and even years,” he said.

“The difference in short term survival may seem modest, but improvement in long-term survival is substantial for this type of cancer,” he added.

Professor Dan Palmer, from The Clatterbridge Cancer Centre in Liverpool and lead oncologist on the trial, described the findings as a “significant step forward”.

Clatterbridge Cancer Centre NHS Foundation Trust

New chemo combination backed for pancreatic cancer

Dan Palmer

“The cure rate after surgery alone is less than 10%,” he said. “Surgery plus the single chemotherapy treatment sees a cure rate of just under 20%.

“This research has found that surgery plus the combination of both chemotherapy drugs sees this figure increase to nearly 30%,” he said. “So we have seen not just extension of life but an increase in the cure rate.”

Professor Peter Johnson, Cancer Research UK’s chief clinician, noted that pancreatic cancer was “notoriously difficult” to treat.

“Nearly 10,000 patients are diagnosed each year in the UK so we urgently needs new ways to treat and manage the disease,” he said.

“Research that tells us more about how the disease grows and spreads – and trials like this one – will be key to improve survival for patients living with the disease,” he added.

Latest Cancer Research UK figures show around 9,400 people are diagnosed with pancreatic cancer each year in the UK and around 8,800 people die from the disease each year. It is the fifth most common cause of cancer death in the UK.

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