Combinations of pancreatic cancer chemotherapy drugs and other agents and/or vaccines are sometimes used as part of pancreatic cancer clinical trials.
Click on the link for information on currently open pancreatic cancer clinical trials in the UK
There is currently an ESPAC-4 trial which is comparing gemcitabine alone with a combination of gemcitabine and capecitabine (GemCap) in patients following surgery for pancreatic cancer. Some centres in the UK will offer GemCap treatment outside of the trial setting in patients with more advanced disease, so ask your oncologist if this treatment may be suitable for you.
The American Society of Clinical Oncology recently published its Clinical Cancer Advances 20101 and hailed a new drug combination, FOLFIRINOX as being the most significant advance for pancreatic cancer this year.
It is the very first randomised Phase III trial in patients with metastatic (spread to other parts of the body) pancreatic ductal adenocarcinomas to demonstrate a significant improvement in survival.
In the french trial, 250 patients were randomised to receive either FOLFIRINOX (a combination of chemotherapy drugs fluorouracil [5-FU], leucovorin, irinotecan and oxaliplatin) or standard single-drug treatment, gemcitabine.
However – this combination can be difficult to tolerate and will usually only be given to patients who have a good performance status i.e., are very fit and well.
Abraxane® (also known as nab-paclitaxel) has been used in combination with gemcitabine within clinical trials and some oncologists in the UK will offer this to patients with advanced disease if there is approval from the Primary Care Trust (PCT). Phase III trial results have showed that nab-pactlitaxel plus gemcitabine was superior to gemcitabine alone.
Abraxane (an albumin-bound nanoparticle formulation of paclitaxel) depletes surrounding stroma and will kill cancer cells but crutially it also produces molecules that block an enzyme called cytidine deaminase (CDA). This molecule normally destroys the drug gemcitabine. So, by using Abraxane in conjunction with gemcitabine, the amount of gemcitabine getting into the tumours is increased thereby making it much more effective.
Other drug combinations used to treat pancreatic cancer:
- In some instances, gemcitabine has been given with other platinum- based drugs such as Cisplatin or Oxaliplatin (Eloxatin® ). These drugs contain an atom of the metal platinum. The drug forms DNA cross links via the platinum which damage the cancer cells.
- Gemcitabine has also been combined with a drug called Mitomycin which works by permanently sticking the cancer cell’s DNA (the cell’s genetic code) together so the cell cannot divide thereby stopping the cancer from growing.
- Gemcitabine has also been used along with a biological therapy, erlotinib (Tarceva®). Used in trials for people with metastatic (spread to other parts of the body) pancreatic cancer, erlotinib works by interfering with the way that cancer cells grow and divide.
Gris et al., (2010) Clinical Cancer Advances 2010: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J. Clin Oncol 33 ↩