Impact of gemcitabine on the treatment of metastatic pancreatic cancer

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Abstract
A previous randomized trial showed gemcitabine was superior to 5-fluorouracil in overall patient survival. However, the incremental improvement in survival was minimal. It is 2.5 years since gemcitabine has become available for the treatment of pancreatic cancer in clinical practice in Japan. The current study was conducted to examine whether treatment outcomes have changed since the introduction of gemcitabine therapy. Ninety-one consecutive patients with metastatic pancreatic cancer treated with systemic chemotherapy at the National Cancer Center Hospital East were surveyed. Patients admitted before April 2001 received 5-fluorouracil, and those admitted subsequently received gemcitabine. The patients were divided into the gemcitabine group (n = 50) and the non-gemcitabine group (n = 41), and these groups were compared for five outcomes, objective response rate, non-progressive disease rate, carbohydrate antigen (CA)19-9 response rate, actual survival time, and difference between estimated and observed survivals. The estimated survival time was determined using the prognostic index reported in the previous study. Except for the objective response rate, the four other outcomes in the gemcitabine group were significantly superior to those in the non-gemcitabine group. The frequency of non-progressive disease, CA19-9 response, and favorable prognosis compared with the estimated survival, were 58%, 22%, and 60%, respectively, in the gemcitabine group, and 22%, 6%, 30%, respectively, in the non-gemcitabine group. The median survival time in the gemcitabine and non-gemcitabine group was 5.73 and 2.87 months, respectively. It is suggested that there was a definite improvement in pancreatic cancer treatment after gemcitabine was introduced.