Chemo Extends Lives of Patients with Rare Pancreatic Cancer

Periampullary adenocarcinoma survival extended with adjuvant chemotherapy

(RxWiki News) Periampullary cancer, a rare form of pancreatic cancer, is actually a collection of malignancies. This cancer (adenocarcinoma) forms in and around the top of the pancreas in places like the ampulla where the bile and pancreatic ducts connect.

Patients with periampullary cancer who received chemotherapy and surgery lived longer than patients who did not receive the chemotherapy.

This is the finding of a large multi-center research effort that was published in the July 11 issue of JAMA (Journal of the American Medical Association).

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According to background information, about 80 percent of periampullary adenocarcinomas (PA) can be surgically removed. While it's known that chemotherapy after surgery extends the lives of those diagnosed with pancreatic cancer, no randomized clinical trials have focused on PA.

For this study, John P. Neoptolemos, MD, of the University of Liverpool, England, and colleagues sought to see if adjuvant (after surgery) chemotherapy using the standard drugs - fluorouracil or gemcitabine - would extend life. 

The randomized trial involved 428 patients from 100 centers in Europe, Australia, Japan and Canada. The individuals had ampullary, bile duct and other cancers. 

The group was randomly assigned to receive either fluorouracil plus a folinic acid regimen, gemcitabine rounds or would serve in the observation (control group).

By the time the primary analysis too place, 57 percent (244) patients had died - 88 in the observation group; 83 in the fluorouracil plus folinic acid group and 73 in the gemcitabine group.

People in the observational group lived a median (midpoint) of 35.2 months, compared to 43.1 in the chemotherapy group.

"This an important large international multi-center study showing the benefit of chemotherapy after surgical resection of a specific type of periampullary cancer," James Farrell, MD, director of the University of California Los Angeles Medical Center Endoscopic Ultrasound Division of Digestive Diseases, told dailyRx in an email.

"It supports the use of adjuvant treatment with gemcitabine for this group of patients," Dr. Farrell said.

Additional study is needed to learn more about this treatment option. "There were different survival outcomes by tumor type, although age, poorly differentiated tumor grade, and lymph node involvement were also independent survival factors,” the authors wrote.

The study was supported by Canada Research United Kingdom, National Cancer Institute of Canada, Canadian Cancer Society among organizations in the Canada, US and Australia.

The authors declare no conflicts of interest.

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Review Date: 
July 10, 2012