Capecitabine vs. Gemcitabine for Pancreatic Cancer

Capecitabine was less toxic for patients with advanced, inoperable disease.

The treatment for locally advanced and inoperable pancreatic cancer is controversial, with studies indicating an inconsistent benefit for adding radiotherapy to chemotherapy. The optimal chemotherapy agent to use with concurrent radiotherapy is also not clearly established; although gemcitabine is superior to 5-fluorouracil for metastatic disease, fluorinated pyrimidine-based adjuvant chemotherapy is equivalent to gemcitabine after surgery.

Now, investigators from the U.K. report the results of a phase II, multicenter, open-label, randomized trial comparing the use of radiotherapy with either oral capecitabine to weekly gemcitabine in 114 adults with locally advanced and inoperable pancreatic cancer. Patients received induction chemotherapy with gemcitabine (1000 mg/m2 weekly) and capecitabine (830 mg/m2 twice daily) for 3 out of 4 weeks for 3 months. The 74 patients without disease progression after induction received a further cycle of gemcitabine and capecitabine followed by radiotherapy (5040 cGy in 180 cGy daily fractions) with either gemcitabine (300 mg/m2 weekly for 6 doses) or capecitabine (830 mg/m2 twice daily, 5 days per week). Most patients had performance status 1 (58%) and head of the pancreas tumors (84%–86%).

Grade 3 or 4 nonhematologic toxicities were similar with gemcitabine and capecitabine (26% and 12%, respectively); grade 3 or 4 hematologic toxicities were more common with gemcitabine (18% vs. 0%; P=0.008). The primary endpoint, 9-month progression-free survival, was similar with capecitabine and gemcitabine (62.9% and 51.4%, respectively); median overall survival was longer with capecitabine (15.2 vs. 13.4 months; hazard ratio, 0.50; P=0.003).

CITATION(S):

Mukherjee S et al. Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): A multicentre, randomised, phase 2 trial. Lancet Oncol 2013 Apr; 14:317.