Annals of Oncology Advance Access published online on July 28, 2007
Annals of Oncology, doi:10.1093/annonc/mdm283
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© 2007 European Society for Medical Oncology
Increased survival using platinum analog combined with gemcitabine as compared to single-agent gemcitabine in advanced pancreatic cancer: pooled analysis of two randomized trials, the GERCOR/GISCAD intergroup study and a German multicenter study
1 Medical Clinic III, Klinikum Grosshadern, Munich, Germany
2 Ospedali Riuniti, Bergamo, Italy
3 Wissenschaftlicher Service Pharma, Langenfeld, Germany
4 Service d'Oncologie, Médecine Interne, Hôpital St. Antoine, Paris, France
* Correspondence to: Dr V. Heinemann, Medical Clinic III, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. Tel: +49-89-7095-0, Fax: +49-89-7095-5257; E-mail: Volker.Heinemann{at}med.uni-muenchen.de
Background: The aim was to evaluate the efficacy of gemcitabine combined with a platinum agent compared to single-agent gemcitabine in a pooled analysis of two randomized trials.
Methods: The French Multidisciplinary Clinical Research Group (GERCOR)/Italian Group for the Study of Gastrointestinal Tract Cancer (GISCAD) intergroup study comparing gemcitabine plus oxaliplatin to gemcitabine and a German multicenter trial comparing gemcitabine plus cisplatin versus gemcitabine were included in a pooled analysis based on individual patient data.
Results: Among 503 evaluable patients, 252 received gemcitabine plus a platinum analog (GP), while 251 patients were treated with gemcitabine alone. For progression-free survival (PFS), the pooled univariate analysis indicated a hazard ratio (HR) of 0.75 (P = 0.0030) in favour of the GP combination. The benefit from the GP combination was greatest in the subgroup of patients with performance status (PS) = 0 (HR = 0.64; P = 0.013). Also overall survival was significantly superior in patients receiving the GP combination (HR = 0.81; P = 0.031). Again, patients with PS = 0 appeared to have a greater benefit from treatment intensification (HR = 0.72; P = 0.063).
Conclusion: The pooled analysis of the GERCOR/GISCAD intergroup study and the German multicenter study indicates that the combination of gemcitabine with a platinum analog such as oxaliplatin or cisplatin significantly improves progression-free survival and overall survival as compared to single-agent gemcitabine in advanced pancreatic cancer. The benefit seems to prevail in patients with a good performance status.
cisplatin, combination therapy, gemcitabine, oxaliplatin, pancreatic cancer, prognostic factors
Received for publication February 2, 2007. Revision received May 11, 2007. Accepted for publication May 14, 2007.
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