LAP07: chemoradiotherapy versus continued chemotherapy for locally advanced pancreatic cancer controlled after four months of gemcitabine
Adding radiotherapy after four months of chemotherapy did not help patients with inoperable pancreatic cancer confined to the pancreas live longer, though it delayed regrowth at the original site. Nor did adding the pill erlotinib to gemcitabine. The result pushed radiotherapy out of the routine pathway for locally advanced disease.
Overview
International open-label randomised phase 3 trial with two randomisations: 449 patients with locally advanced pancreatic cancer received gemcitabine with or without erlotinib, and the 269 whose disease had not progressed after four months were randomised again to capecitabine-based chemoradiotherapy (54 Gy) or two further months of the same chemotherapy.
Median overall survival was 15.2 months with chemoradiotherapy and 16.5 months with chemotherapy alone (hazard ratio 1.03), and 11.9 against 13.6 months with and without erlotinib. Chemoradiotherapy reduced local progression (about 32 against 46 percent) and lengthened the interval off treatment, without more grade 3 or 4 toxicity apart from nausea.
- Median overall survival 15.2 months with chemoradiotherapy versus 16.5 months with continued chemotherapy, hazard ratio 1.03.
- Erlotinib added to gemcitabine did not improve survival (11.9 versus 13.6 months).
- Local progression fell from about 46 to 32 percent with chemoradiotherapy.
Systemic chemotherapy is the backbone for locally advanced pancreatic cancer; consolidation chemoradiotherapy is an option to control local symptoms or as a bridge to surgery rather than a survival treatment.
- Gemcitabine was the chemotherapy; whether radiotherapy adds to FOLFIRINOX or gemcitabine plus nab-paclitaxel remains an open question.
- Conventional fractionation was used; stereotactic and dose-escalated radiotherapy are being tested separately.
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