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Metastatic Disease

Metastatic Disease

There is no conclusive evidence that gemcitabine is superior to 5FU as first line therapy for patients with pancreatic cancer. At this time, no single agent can be recommended as standard first line therapy. Combination chemotherapy has been shown to:

  1. increase the rate of response
  2. prolong overall survival
  3. maintain an improved quality of life

When compared to single agent gemcitabine. Combinations that have shown to be both safe and effective include:

  1. 5FU, leucovorin, irinotecan, oxaliplatin (FOLFIORINOX)
  2. Abraxane with gemcitabine
  3. 5FU, leucovorin, paclitaxel, oxaliplatin
  4. 5FU, leucovorin, oxaliplatin

It has been recommended that single agent therapy with either gemcitabine or capecitabine is acceptable treatment for patients with stage IV disease who have a poor performance status. There is no data to support this. Stoniolo et al. is an open label single-arm design with more than 2000 patients having metastatic pancreatic cancer who were treated with gemcitabine, reported a median survival of only 4.3 months. Most of those patients had a good performance status. The package insert from Eli Lilly states that the confirmed objective response rate from gemcitabine was 0%. Of 41 consecutive patients I have treated with single agent gemcitabine only one patient was observed to have an objective response.