SAN FRANCISCOTwo phase II chemotherapy regimens combining
gemcitabine (Gemzar) and docetaxel (Taxotere) in patients with advanced
pancreatic cancer show higher response rates than gemcitabine alone and suggest
further explorations of the combination are warranted, according to
presentations at the 37th Annual Meeting of the American Society of Clinical
Robert C. Shepard, MD, associate professor of medicine, University of
Virginia Cancer Center, Charlottesville, pointed out that some of the highest
response rates in pancreatic cancer have been reported with docetaxel, and many
in vitro studies suggest synergism between docetaxel and gemcitabine. Also, the
combination has been effective in lung cancer. "Pancreatic cancer is even
more resistant than lung cancer to chemotherapy, which is why we wanted to look
at the combination in pancreatic cancer," Dr. Shepard said.
In Dr. Shepard’s ECOG trial (abstract 614), patients received intravenous
docetaxel (75 mg/m² over 1 hour) then gemcitabine (2,000 mg/m² over 30 minutes)
given biweekly for four cycles. The 32 patients received a median of four
cycles of therapy (range, 1 to 12).
At a median follow-up of 8.6 months, there were two confirmed complete
responses, two partial responses, and three patients with no change. The
overall response rate was 12.5%; including stable disease, the rate was 22%.
Eight patients (25%) were alive at the time of the presentation. One of the
complete responders remained progression free, Dr. Shepard said.
Neutropenia was the most common severe toxicity (grade 3-4), with 13 events.
Dehydration and fatigue were reported 7 and 6 times, respectively. There were 6
occurrences of grade 3 or higher febrile neutropenia. One patient expired with
a myocardial event. There was no pulmonary toxicity.
Noting that response rates with gemcitabine alone are in the 6% to 9%
range, Dr. Shepard commented: "It’s an advance, but not a home run. You
can say that it is almost a 50% gain in median survival, but in absolute
numbers, the change is not that big."