Chemo combo could help pancreatic cancer patients live longer after surgery

A combination of chemotherapy drugs was better than a single drug at extending the lives of pancreatic cancer patients after surgery, according to an unpublished clinical trial.

Patients who received the combination of four drugs lived an average of 20 months longer than those who received the single drug after surgery, which is the current standard of care.

But the combination treatment came with worse side effects, although the researchers said these were manageable.

Results of the trial, funded by the Institut National du Cancer, are being presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

Chemo combo boosted survival

The phase 3 PRODIGE trial included 493 patients who had surgery to remove tumours in their pancreas and were well enough after their operation to have chemotherapy.

Around half were given the drug gemcitabine (Gemzar), the most common treatment after surgery, and the rest had a combination of four drugs called FOLFIRINOX.

FOLFIRINOX is usually the first treatment patients have if their pancreatic cancer is too advanced to be surgically removed. But patients must be well enough for the combination chemotherapy. FOLFIRINOX is not routinely given after surgery.

In the trial, taking the drug combination after surgery significantly increased the amount of time patients were disease free after treatment. It also improved overall survival.

The group who had gemcitabine went for an average of 12.8 months without their disease returning after treatment. Those who took FOLFIRINOX were disease free for an average of 21.6 months.

Average overall survival in patients who were given the standard gemcitabine was 34.8 months compared to 54.4 months in those who had FOLFIRINOX.

“For the first time, our trial shows a large benefit from adjuvant FOLFIRINOX chemotherapy over standard chemotherapy with gemcitabine, showing we can help patients with pancreatic cancer live much longer,” said lead researcher Dr Thierry Conroy, director of the Institut de Cancerologie de Lorraine in Nancy.

Drug could benefit some patients

Professor Andrew Biankin, a Cancer Research UK-funded pancreatic cancer expert at the University of Glasgow, said: “Pancreatic cancer is very difficult to treat so any significant advance like this one is terrific.”

He added that FOLFIRINOX is the most effective chemotherapy combination for people with pancreatic cancer that has spread, but is also the most aggressive treatment.

“Because of this, only a proportion of patients are fit enough to benefit from FOLFIRINOX. It is excellent news that some patients will now potentially be offered adjuvant therapy with FOLFIRINOX.”

The researchers said the next step will be to test when is the best time for the chemotherapy. Offering the combination before surgery, so called neoadjuvant therapy, could give further benefits, said Dr Conroy.

Biankin said that previous research suggests that the best responses to treatment could be determined by the biology of the cancer. And further research should focus on studying the samples collected during the trial.

“I look forward to an in-depth molecular analysis of the tissue and blood samples from the patients who took part in the study, to see if we can better predict who would respond well to the treatment. This information will help us decide who could benefit and help us to give this effective therapy to a greater number of patients.”

Where did these results come from?

The ASCO annual meeting is the largest gathering of clinical cancer experts in the world.

Researchers share preliminary and more advanced results. These come from small, early stage studies through to large randomised clinical trials.

In some cases, the results will go on to change how patients are treated. But most of the results are yet to be published in a scientific journal, so only offer an early glimpse of what these trials may later confirm.