A mix of chemotherapy drugs could be considered for treating advanced pancreatic cancer, say Italian doctors in The Lancet Oncology's online edition.

Pancreatic cancer has a poor prognosis. More than 80 percent of patients are diagnosed when the disease is already in advanced stages, says the new study, which was conducted by doctors including Michele Reni, MD, of San Raffaele H. Scientific Institute in Milan, Italy.

Pancreatic cancer has subtle symptoms. At the time of diagnosis the cancer may have spread and infiltrated blood vessels and the liver, making a chance for cure difficult. With standard chemotherapy treatment, less than one-third of patients survive past one year.

However, the researchers say because their study was small, larger studies are needed "before this combination regimen could be regarded as standard treatment."

The combination includes four drugs — cisplatin, epirubicin, fluorouracil, and gemcitabine. That mix, dubbed "PEFG", was compared to gemcitabine alone, the current standard treatment.

About twice as many people in the PEFG group survived for four months without their disease progressing. One and two years later, overall survival rates were also higher with PEFG, says the study.

About Pancreatic Cancer

In the U.S., pancreatic cancer is the fourth leading cause of cancer death in men and the fifth in women, says the American Cancer Society (ACS). About 32,180 people will be diagnosed with pancreatic cancer and about 31,800 will die of the disease, says the ACS.

Aside from advanced age, smoking is the main risk factor for pancreatic cancer; a smoker is three to four times more likely than a nonsmoker to get the disease. People frequently exposed to certain petroleum products may also be at increased risk. Excessive dietary fat and protein as well as low-fiber intake may promote the disease.

Drug Combination vs. Standard Treatment

The study included 104 people with advanced pancreatic cancer. They were 18-70 years old and were followed for at least two years.

Patients were assigned to get the PEFG drug combination or gemcitabine alone. The researchers wanted to compare the length of time during and after treatment that the cancer did not grow.

In the PEFG group, 60 percent survived four months without their cancer progressing, compared with 28 percent of the gemcitabine group. The PEFG group also had a higher overall survival rate at one year than the gemcitabine group (39.5 percent compared with 21.3 percent).

After two years, five PEFG patients were still alive. So was one person in the gemcitabine group.

"The proportion of patients with one-year and two-year survival was greater in the PEFG group than in the gemcitabine group," says the study.

Side Effects, Quality of Life

Side effects, relating to blood abnormalities from the cancer-fighting medications, "were significantly higher in patients assigned combination treatment than in those assigned gemcitabine, but were of short duration and were manageable," say the researchers.

As for quality of life, Reni and colleagues say this: "Although conventional statistical testing was not done, we noted that patients allocated PEFG were 20 percent to 44 percent more likely to obtain a clinically relevant improvement in scores for emotional functioning, overall quality of life, cognitive measures, pain, fatigue, indigestion, dyspnoea, appetite loss, and flatulence than those allocated gemcitabine."

The gemcitabine group reportedly fared better in two regards. "Patients in the gemcitabine group had better scores for sexual function and body image than did those in the PEFG group," says the study.

Treatment of the Future?

Cautioning that larger studies are needed, Reni and colleagues say their findings are nevertheless important "because PEFG had manageable toxic effects, did not negatively affect quality of life, and maintained a clinically and statistically relevant outcome advantage compared to standard treatment."

"Accordingly, PEFG might be a feasible and effective first-line treatment for patients with locally advanced or metastatic pancreatic adenocarcinoma," says the study.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Reni, M. The Lancet Oncology, May 10, 2005; online edition. News release, The Lancet. American Cancer Society: "How Many People Get Pancreatic Cancer." American Cancer Society: "How Is Pancreatic Cancer Found?" American Cancer Society: "What Is Pancreatic Cancer?"