M.D. Anderson Cancer Center, 1515 Holcombe Blvd Unit 426, Houston, TX, 77030, USA,
Invest New Drugs. 2013 Oct;31(5):1375-83. doi: 10.1007/s10637-013-9967-2. Epub 2013 May 4.
Metastatic pancreatic cancer carries a poor prognosis, with median survival on the order of several months. There is evidence that combining gemcitabine with either erlotinib or cisplatin may be superior to single agent gemcitabine in patients with good performance (PS 0-1). We retrospectively compared outcomes of patients treated with either the three drug regimen of gemcitabine, cisplatin, and erlotinib (GCE) or the doublet of gemcitabine and cisplatin (GC) in order to assess the potential benefit of erlotinib. We also evaluated the role of erlotinib among smokers and non-smokers. We retrospectively analyzed 145 patients who presented between 2006 and 2009 with previously untreated metastatic pancreatic cancer initially treated at the M.D. Anderson cancer center with either GC or GCE. Information on tumor characteristics and overall survival time (OS) was collected by medical record review. Kaplan-Meier curves were used to estimate OS. Log rank tests were used to compare OS between groups. The Cox proportional hazards regression model was used to evaluate the ability of patient prognostic variables or treatment group to predict OS. A total of 71 patients were treated with GC, while 74 were treated with GCE. Cox analyses found no significant difference in overall survival (median 5.5 vs. 8.0 months, respectively, p-value=0.1). Small sampling numbers may have contributed to this result. One year survival was 23 % in the GCE group and 13 % in the GC group. Patients with poor performance status (PS=2-3) had worse survival as compared to patients with better performance status (PS=0-1, p=0.001). As in earlier studies, patients treated with more lines of therapy tended to have better survival (p <0.0001), and CA19-9 was found to be a significant predictor for OS (p=0.001). No statistical evidence of a survival difference was found between smokers and non-smokers in both treatment groups (p=0.72). In conclusion, though there was a trend towards improved survival with the addition of erlotinib to gemcitabine and cisplatin, this does not reach statistical significance.
转移性胰腺癌预后不良，中位生存期为数月。有证据表明，在体能状态（PS）良好的患者（0-1 分）中，吉西他滨联合厄洛替尼或顺铂可能优于单药吉西他滨。我们回顾性比较了接受吉西他滨、顺铂和厄洛替尼三联方案（GCE）或吉西他滨和顺铂双联方案（GC）治疗的患者的结局，以评估厄洛替尼的潜在获益。我们还评估了厄洛替尼在吸烟者和非吸烟者中的作用。我们回顾性分析了 2006 年至 2009 年间在 M.D.安德森癌症中心初治的 145 例未经治疗的转移性胰腺癌患者的资料，这些患者最初接受 GC 或 GCE 治疗。通过病历回顾收集肿瘤特征和总生存时间（OS）信息。Kaplan-Meier 曲线用于估计 OS。对数秩检验用于比较组间 OS。Cox 比例风险回归模型用于评估患者预后变量或治疗组预测 OS 的能力。共 71 例患者接受 GC 治疗，74 例患者接受 GCE 治疗。Cox 分析发现总生存时间无显著差异（中位数分别为 5.5 个月和 8.0 个月，p 值=0.1）。小样本量可能导致了这一结果。GCE 组和 GC 组 1 年生存率分别为 23%和 13%。体能状态（PS）较差（PS=2-3）的患者与体能状态较好（PS=0-1）的患者相比，生存状况更差（p=0.001）。与早期研究一样，接受更多线治疗的患者生存状况更好（p<0.0001），CA19-9 是 OS 的显著预测因素（p=0.001）。在两组治疗中，均未发现吸烟者和非吸烟者之间生存差异有统计学意义（p=0.72）。总之，虽然吉西他滨联合顺铂加厄洛替尼治疗有改善生存的趋势，但无统计学意义。
