A combination of two chemotherapy drugs – gemcitabine and capecitabine – should be the new standard of care for pancreatic cancer patients who have had surgery to remove their tumour, according to a Cancer Research UK-funded study published in The Lancet.
Experts say the combination should replace the standard treatment of giving patients gemcitabine alone following surgery.
Twenty-nine per cent of patients given the drug combination lived for at least five years compared with only 16 per cent of patients given gemcitabine alone.**
Peter Breaden, 67, a retired lab manager and grandfather of five from Merseyside, was diagnosed with pancreatic cancer in April 2010. Following surgery in May 2010 he was to start chemotherapy in the July and was offered the chance to take part in the ESPAC 4 trial. Peter said: “I know that new drugs and techniques need to be developed so when the doctors told me about the trial, there was no hesitation in my mind – I wanted to get involved.
“I was very grateful for the opportunity to contribute to this trial. For six months I had chemotherapy on three weekly cycles after my surgery. I am pleased to have been part of a trial that has been such a success. Research is absolutely essential and needs all our support.”
The results, which were first presented at the American Society of Clinical Oncology (ASCO) in June 2016 but have now been peer-reviewed, show that this treatment plan is predicted to double the number of patients who survive their disease for at least five years.
Trial lead, Professor John Neoptolemos at 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. The difference in short term survival may seem modest, but improvement in long-term survival is substantial for this type of cancer.”
This recommendation follows results from a clinical trial of 732 patients in hospitals across the UK, German, Sweden and France.
Around half of patients on the trial received gemcitabine and the other half received a combination of gemcitabine and capecitabine.
There was no significant difference in side effects*** between the patients on the standard treatment and the combination treatment.
This trial was set up in 2008 to address the poor pancreatic cancer survival rates.
The latest Cancer Research UK figures show that 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.
Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “Pancreatic cancer is a notoriously difficult disease 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.
“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. There are still big leaps to be made, but Cancer Research UK is investing heavily into research to take on pancreatic cancer, and we are just starting to see the results.”
* Neoptolemos et al., Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. The Lancet, 2017
** Increased from 16.3 per cent with surgery and gemcitabine to 28.8 per cent for surgery and a combination of gemcitabine and capecitabine
*** Side effects include 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.
**** Pancreatic cancer is the fifth most common cause of cancer death in the UK.
ESPAC-4 is a multicentre, open label, randomised phase 3 trial