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Summary: A cocktail of four different chemotherapy drugs appears better than gemcitabine alone, the standard drug for treating pancreatic cancer. According to a study from Italy, the combination treatment, which included gemcitabine, was better at shrinking tumors, slowed the progression of the disease after 4 months, and kept more people alive. People on the combination also appeared to feel better. The results were published in the journal Lancet Oncology.

Why it's important: Pancreatic cancer is our most deadly cancer: 80% of patients are diagnosed too late to be helped by surgery. Of those that may be helped by surgery, fewer than 40% are cured. Overall, only 20% of patients live 1 year after diagnosis, and just 4% live 5 years. Even a small benefit from a new treatment is important for patients facing this cancer.

What's already known: Most chemotherapy drugs have been ineffective in treating this disease. Gemcitabine is the only drug that has much effect, and it primarily helps patients feel better with only a slight slowing of the cancer's growth. Doctors are now building on these results by testing the effect of adding other chemotherapy drugs to gemcitabine.

How this study was done: One hundred and four patients with advanced pancreatic cancer were divided into 2 groups. Patients in one group were treated with gemcitabine. Patients in the other were given gemcitabine and 3 additional drugs: cisplatin, epirubicin, and fluorouracil. They were then followed for at least 24 months, unless they died earlier. The treating doctors measured changes in the size of the tumors, how long it took for the cancer to begin growing after treatment, and how long the patients lived. They also noted any toxic effects of the drugs and any change in the patients' cancer-related symptoms.

What was found: Patients who received the 4-drug regimen were helped more than those who got only gemcitabine. By 4 months after the treatment had started, the cancers had shrunk by more than half in 38.5% of patients who received the combination compared to only 8.5% of the patients receiving gemcitabine alone. Also, at that 4-month point, the cancer had been held in check in 60% of the patients given the combination compared to 28% of those receiving only gemcitabine. Finally, at the end of 1 year, more patients who received the combination were still alive compared with the gemcitabine-only group (38.5% vs. 21%), although this difference was not statistically significant. Toxic side effects did not differ much between the two groups, and in general, patients receiving the combination tended to feel better.

Citation: "Gemcitabine versus cisplatin, epirubicin, fluorouracil, and gemcitabine in advanced pancreatic cancer: a randomized controlled multicentre phase III trial." Published in the Lancet Oncology, Vol. 6, No. 6:369-376. First author: Michele Reni, San Raffaele H. Scientific Institute, Milan, Italy.