Induction chemotherapy with gemcitabine followed by concurrent chemoradiotherapy with capecitabine in patients with locally advanced pancreatic cancer

Objective: To evaluate the safety and efficacy of induction chemotherapy with gemcitabine followed by concurrent chemoradiotherapy with capecitabine in patients with locally advanced pancreatic cancer (LAPC). Methods: A total of 42 patients with locally advanced pancreatic cancer were enrolled. All patients received seven cycles of induction chemotherapy of gemcitabine 1000 mg/m², once a week. Concurrent chemoradiotherapy began 1 week after completion of induction chemotherapy. Radiotherapy was delivered with a median dose of 54 Gy (34-64 Gy) with 1.8-2.0 Gy in a fraction. The radiotherapy was combined with capecitabin at a dosage of 825 mg/m² twice daily, 5 d/week. Results: Twenty patients (47.6%) were evaluated as clinical benefit response (CBR). Two cases were observed with complete remission (CR), 8 with partial remission (PR), 27 with stable disease (SD), and 5 with progressive disease (PD). The median overall survival was 10.1 months (range of 4-36 months). The 1-, 2-year overall survival rate was 38.2% and 18.2%, respectively. Myelosuppression was recorded in 20 patients with grades 1-2, and 5 patients with grade 3. Twenty-two patients suffered from grade 1-2 gastrointestinal toxicities, while 4 patients suffered from grade 3. Conclusions: The preliminary results showed that induction chemotherapy with gemcitabine followed by concurrent chemoradiotherapy with capecitabine in patients with LAPC might achieve encouraging efficacy with better tolerance. (authors)