A major international trial has shown a commonly used chemotherapy drug is as effective at helping prevent pancreatic cancer returning after surgery as the more expensive standard chemotherapy treatment, reveals a study published in the Journal of the American Medical Association today (Wednesday).
The results of the Cancer Research UK- funded study mean the cheaper drug – called 5-fluorouracil (5-FU) – could be prescribed in cases when the standard chemotherapy – gemcitabine – has failed, providing an extra lifeline for patients whose cancer comes back after surgery.
They also raise hopes that a new trial* currently underway, looking at combining an oral version of 5-FU with the standard treatment of gemcitabine, could lead to a more effective treatment for pancreatic cancer patients who are eligible for surgery.
Pancreatic cancer is the eleventh most common cancer in the UK, where nearly 7,800 people are diagnosed with the disease each year. But survival rates remain a major concern – only around three per cent of patients survive for more than five years, although five-year survival improves to around ten per cent for patients suitable for surgery.
Lead researcher Professor John Neoptolemos, who is director of the Liverpool Cancer Research UK Centre based at the University of Liverpool, said: “Until now the best way to treat pancreatic cancer has been unclear. But these results are the first to directly compare these two chemotherapies and show undoubtedly that they are both as effective as each other.
“Importantly this means patients now have a backup in case their cancer fails to respond to the first line of treatment. A new trial investigating whether combining these two treatments could be even more effective and prolong life is already underway and we look forward to seeing the result.
“We’re still a long way from being able to reduce the number of people who die from this disease, but this research is a vital step in the right direction.”
The trial, called European Study Group for Pancreatic Cancer (ESPAC)-3, is the largest of its kind and involved 159 centres in Europe, Australasia, Japan and Canada which between them recruited 1088 patients who had undergone surgery for pancreatic cancer.
One group had the standard chemotherapy treatment – gemcitabine. The second group had a cheaper widely available drug called 5-fluorouralcil (5-FU) that is commonly used in cancer treatment already.
The results mean that 5-FU should now also be considered one of the standard options for the treatment of patients with this disease.
They build on earlier trial results suggesting patients who had surgery and chemotherapy had better a chance of survival than patients who only had surgery.
Kate Law, director of clinical research at Cancer Research UK, said: “Pancreatic cancer remains one of the hardest cancers to treat.
“Finding out these two drugs are as effective as each other at preventing pancreatic cancer returning after surgery is important. It raises hopes that a new trial currently looking at giving two similar drugs together could be successful at preventing or at least delaying pancreatic cancer returning after surgery.
“Previous trial results involving advanced pancreatic cancer patients have shown this drug combination can give precious extra months or even years of life, so there is reason to be hopeful the survival benefit could be even more marked for patients who are eligible for surgery.”
For media enquiries please contact the Cancer Research UK press office on 020 7061 8300 or, out-of-hours, the duty press officer on 07050 264 059.
Neoptolemos J.P. et al., Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection (2010), JAMA.
The ESPAC-4 trial*
The ESPAC-4 trial launched in 2008 after early results from the ESPAC-3 trial and others suggested that adding an additional chemotherapy drug – capecitabine (the tablet for of 5-FU) – to the standard chemotherapy – gemcitabine – could help prevent pancreatic cancer returning after surgery.
Cancer of the pancreas is very difficult to treat. If possible, doctors use surgery to remove the cancer. But even if the cancer is removed, there is a risk that it will come back. Some trials have shown that having chemotherapy after surgery helps to stop or delay the cancer coming back.