Chemotherapy and Radiation Therapy in Treating Patients With Locally Advanced Pancreatic Cancer

Eastern Cooperative Oncology Group

Status and phase

Completed

Phase 2

Conditions

Pancreatic Cancer

Treatments

Procedure: neoadjuvant therapy

Drug: gemcitabine hydrochloride

Drug: fluorouracil

Drug: cisplatin

Procedure: conventional surgery

Biological: epoetin alfa

Procedure: adjuvant therapy

Radiation: radiation therapy

Biological: filgrastim

Study type

Interventional

Funder types

NETWORK

NIH

Identifiers

NCT00049348

E1200

CDR0000258056

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy before surgery may shrink the tumor so that it can be removed during surgery.

PURPOSE: Randomized phase II trial to compare the effectiveness of two different regimens combining chemotherapy with radiation therapy in treating patients who are undergoing surgery for locally advanced pancreatic cancer.

Full description

OBJECTIVES:

Compare the percentage of margin-free resections in patients with locally advanced, potentially resectable adenocarcinoma of the pancreas treated with gemcitabine and radiotherapy vs gemcitabine, fluorouracil, and cisplatin followed by radiotherapy and fluorouracil.
Compare the efficacy of these regimens, as measured by CT scan response, in these patients.
Compare the posttreatment fibrosis in resected specimens of patients treated with these regimens.
Compare the toxicity of these regimens in these patients.
Compare the duration of objective response in patients treated with these regimens.
Compare the disease-free and overall survival of patients treated with these regimens.
Compare the effect of these regimens and disease recurrence on CA 19-9 values in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to superior mesenteric vein (SMV)/portal vein (PV) occlusion (yes vs no), SMV/PV/superior mesenteric artery/hepatic artery abutment or narrowing (yes vs no), prior exploration (yes vs no), and whether deemed to require preoperative therapy due to other factors (yes vs no). Patients are randomized to 1 of 2 treatment arms.

Arm I: Patients undergo radiotherapy once daily 5 days a week for 6 weeks. Patients receive gemcitabine IV over 50 minutes once weekly for 6 weeks during radiotherapy. Patients undergo surgical resection 4-6 weeks after completion of chemoradiotherapy.

Maintenance therapy (4-8 weeks after completion of surgery): Patients receive gemcitabine IV over 100 minutes once weekly for 2 weeks. Treatment repeats every 3 weeks for 5 courses in the absence of disease progression or unacceptable toxicity.

Arm II: Patients receive gemcitabine IV over 30 minutes on days 1, 5, 29, and 33; cisplatin IV over 60 minutes on days 1-5 and 29-33; and fluorouracil IV continuously on days 1-4 and 29-32. Patients also receive filgrastim (G-CSF) subcutaneously (SC) daily on days 6-15 and 34-43 and epoetin alfa SC weekly on weeks 1-9. After completion of chemotherapy, patients undergo radiotherapy once daily 5 days a week for 6 weeks. Patients receive fluorouracil IV continuously daily during radiotherapy. Patients undergo surgical resection 4-6 weeks after completion of chemoradiotherapy.

Maintenance therapy (4-8 weeks after completion of surgery): Patients receive gemcitabine IV over 100 minutes once weekly for 2 weeks. Treatment repeats every 3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 2 years and then every 6 months for 2 years.

PROJECTED ACCRUAL: A total of 80-160 patients (40-80 per treatment arm) will be accrued for this study.

Sex

All

Ages

18 to 120 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

Histologically confirmed adenocarcinoma of the pancreas
- No adenosquamous cancers or adenocarcinoma associated with cystic mucinous neoplasms
- Locally advanced disease that is potentially resectable, previously explored and considered unresectable, or deemed to require preoperative treatment for other reasons
- Primary cancer in the head, body, or tail of pancreas
Measurable disease
No 360 degree encirclement of the superior mesenteric artery, hepatic artery, or celiac axis
No metastases by CT scan and laparoscopy (if prior surgery, only CT scan required)

PATIENT CHARACTERISTICS:

Age

18 and over

Performance status

ECOG 0-2

Life expectancy

Not specified

Hematopoietic

Absolute granulocyte count greater than 2,000/mm^3
Platelet count greater than 100,000/mm^3

Hepatic

Bilirubin less than 2 mg/dL (unless secondary to bile duct blockage by tumor)
Biliary obstruction by tumor requires biliary stent at least 9 French or biliary bypass before therapy

Renal