Optimum chemotherapy in the management of metastatic pancreatic cancer

Table 1 Summary of the results of four trials associating Gemcitabine and targeted therapies

Ref.	Regimen	ORR	Median PFS (mo)	Median OS (mo)
Philip et al[10]	Gem/cetuximab	12.5%	3.4	6.3
	Gem	14.0%	3	5.9
Kindler et al[11]	Gem/bevacizumab	13.0%	3.8	5.8
	Gem	10.0%	2.9	5.9
Moore et al[12]	Gem/erlotinib	8.6%	3.75	6.24
	Gem	8.0%	3.55	5.91
Rougier et al[13]	Gem/aflibercept	ND	3.7	6.5
	Gem	ND	3.7	7.8

ORR: Objective response rate; PFS: Progression free survival; OS: Overall survival; ND: Not determined.

Table 2 The approved chemotherapeutical regimens for metastatic pancreatic cancer in patients with good performance status

Ref.	Regimen	ORR	Median OS (mo)	Median PFS (mo)
Burris et al[2]	Gemcitabine	ND	5.65	2.33
	5-FU	ND	4.41	0.92
Conroy et al[3]	FOLFIRINOX	31.6%	11.1	6.4
	Gemcitabine	9.4%	6.8	3.3
Moore et al[12]	Gemcitabine/erlotinib	8.6%	6.24	3.75
	Gemcitabine	8.0%	5.91	3.55
Daniel et al[20]	Gemcitabine/nab-paclitaxel	23%	8.5	5.5
	Gemcitabine	7%	6.7	3.7

ORR: Objective response rate; OS: Overall survival; PFS: Progression free survival; ND: Not determined.

Table 3 The adverse events of three approved regimen for metastatic pancreatic cancer reported in NEJM 2011 and ASCO 2013

Adverse events	Gemcitabine	FOLFIRINOX	Gemcitabine/nab-paclitaxel
Neutropenia	21%	45.7%	38%
Febrile neutropenia	1.2%	5.4%	3%
Thrombocytopenia	3.6%	9.1%	13%
Fatigue	17.8%	23.6%	17%
Diarrhea	1.8%	12.7%	6%
Peripheral neuropathy	0%	9.0%	17%

Table 4 Recent phase II trials studying new agents in the metastatic pancreatic cancer

Reference	New agents	Agents target	Phase of the study and targeted population	Arms of the study	Conclusion of the study
Kindler et al[26]	Ganitumab (AMG479)	mAb antagonist of insulin-like growth factor 1 receptor	Phase II; untreated MPC patients	Gem/ganitumab vs gem	Improved 6-mo survival rate and OS
Bodoky et al[27]	Selumetinib (AZD6244)	Selective MEK inhibitor	Phase II; second line treatment after gemcitabine	Selutimumab vs capecitabine	No significant difference in OS
Wolpin et al[28]	Everolimus (RAD001)	m-TOR inhibitor	Phase II; second line treatment after gemcitabine	Everolimus (single arm study)	Minimal clinical activity
Royal et al[31]	Ipilimumab (MDX010)	Anti-CTLA4	Phase II; untreated MPC patients	Ipilimumab (single arm study)	Ineffective in the treatment of MPC
Wolpin et al[36]	AGS-1C4D4	mAb to prostate stem cell Antigen	Phase II; untreated MPC patients	Gemcitabine/AGS-1C4D4 vs gemcitabine	Improved 6-mo survival rate

MPC: Metastatic pancreatic cancer; OS: Overall survival.