According to research published early online in the Journal of Clinical Oncology, gemcitabine plus radiotherapy improves outcomes compared to gemcitabine alone in the treatment of localised, unresectable pancreatic cancer.

The study included 74 adults with locally unresectable adenocarcinoma of the pancreas who had an ECOG performance status of 0-2 and who had not received any previous treatment (chemotherapy or radiotherapy).  Following stratification by performance status and prior weight loss within the previous six months, they were randomised to receive gemcitabine alone (1000mg/m2 weekly for six weeks followed by one week rest, then weekly for three weeks followed by one week rest, for five additional cycles; n=37) or in addition to radiotherapy (gemcitabine given at 600mg/m2 on the first day of radiotherapy and then weekly thereafter during radiotherapy; resumed at full dose approximately four weeks after completion of radiation for a total of 5 cycles; n=34).

The primary end point was overall survival – this was reported as 9.2 months (95% CI 7.9 to 11.4 months) in the gemcitabine monotherapy arm and 11.1 months (95% CI, 7.6 to 15.5 months) in the combination arm (P=0.017).   A greater incidence of grades 4 and 5 toxicities were seen in the combination group (41% vs. 9% with gemcitabine monotherapy), but grades 3 and 4 toxicities combined were similar (79% and 77%, respectively).  No differences in quality of life measures were reported.

The authors comment that radiotherapy, when administered with gemcitabine, appears to be an important component of first-line therapy in patients with localised unresectable pancreatic cancer, with acceptable toxicity.  However no patient sustained durable disease-free survival, and this trial “further emphasizes that more novel approaches with improved systemic therapy tested in large populations are needed for the treatment of locally advanced pancreatic cancer.”