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Role of 5FU is pancreatic cancer progressing after gemcitabine

Posted Nov 20 2009 10:02pm

5 florouracyl is an older drug but it has some resposne in pancreatic cancer, as does its analogue, Xeloda. Unfortunately its role in combination patients who progressed after gemcitabine is not defined. 5fu with or without leukovorin, or Xeloda alone are often used to salvage pancreatic cancer patients who progress on gemcitabine.

There is an active trial:  Fluorouracil With or Without Cisplatin in Treating Patients With Advanced or Metastatic Cancer of the Pancreas. This study is ongoing, but not recruiting participants, NCT00003029. It is a randomized phase III trial to compare the effectiveness of fluorouracil with or without cisplatin in treating patients who have advanced or metastatic cancer of the pancreas.

NCCN recommends 5FU, 5FU/leukovorin or CapeOx and points out that addition of oxaliplatin improves overal survival.

Practice guideline -

Lutz MP, Ducreux M, Wagener T, et al, Docetaxel/gemcitabine or docetaxel/cisplatin in advanced pancreatic carcinoma: a randomized phase II study of the EORTC-GI group. Proceedings of the American Society of Clinical Oncology 2002;21:125a, abstract 498

Scheithauer W, Schüll B, Ulrich-Pur H, et al, Gemcitabine alone or in combination with capecitabine in patients with advanced pancreatic adenocarcinoma. Proceedings of the American Society of Clinical Oncology;21:126a, abstract number 500, pancreatic

V. Heinemann, R. Labianca, A. Hinke, and C. Louvet
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
Ann. Onc., October 1, 2007; 18(10): 1652 - 1659.

D. H. Palmer, D. D. Stocken, H. Hewitt, C. E. Markham, A. B. Hassan, P. J. Johnson, J. A. C. Buckels, and S. R. Bramhall
A Randomized Phase 2 Trial of Neoadjuvant Chemotherapy in Resectable Pancreatic Cancer: Gemcitabine Alone Versus Gemcitabine Combined with Cisplatin
Ann. Surg. Oncol., July 1, 2007; 14(7): 2088 - 2096.

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