Medline ® Abstract for Reference 60
of 'Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer'
Long-term results and recurrence patterns from SCALOP: a phase II randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer.
Hurt CN, Falk S, Crosby T, McDonald A, Ray R, Joseph G, Staffurth J, Abrams RA, Griffiths G, Maughan T, Mukherjee S
Br J Cancer. 2017;
BACKGROUND: SCALOP, a randomised, phase II trial, tested the activity and safety of gemcitabine (GEM)-based and capecitabine (CAP)-based chemoradiation (CRT) for locally advanced pancreatic cancer (LAPC). Here we present the long-term outcomes.
METHODS: Eligibility: histologically proven LAPC⩽7 cm. Following 12 weeks of induction GEMCAP chemotherapy (three cycles: GEM 1000 mg m(-2) days 1, 8, 15; CAP 830 mg m(-2) days 1-21 q28 days) patients with stable/responding disease, tumour⩽6 cm, and WHO Performance Status 0-1 were randomised to receive one cycle GEMCAP followed by CAP (830 mg m(-2) b.d. on weekdays only) or GEM (300 mg m(-2) weekly) with radiation (50.4 Gy per 28 fractions).
RESULTS: One-hundred fourteen patients (28 UK centres) were registered between 24 December 2009 and 25 October 2011, and 74 were randomised (CAP-RT=36; GEM-RT=38). At the time of this analysis, 105 of the 114 patients haddied and the surviving 9 patients had been followed up for a median of 10.9 months (IQR: 2.9-18.7). Updated median OS was 17.6 months (95% CI: 14.6-22.7) in the CAP-CRT arm and 14.6 months (95% CI: 11.1-16.0) in the GEM-CRT arm (intention-to-treat adjusted hazard ratio (HR): 0.68 (95% CI: 0.38-1.21, P=0.185)); median progression-free survival (PFS) was 12.0 months (95% CI: 10.0-15.2) in the CAP-CRT arm and 10.4 months (95% CI: 8.8-12.7) in the GEM-CRT arm (intention-to-treat adjusted HR: 0.60 (95% CI: 0.32-1.14, P=0.120)). In baseline multivariable model, age⩾65 years, better performance status, CA19.9<613 IU l(-1), and shorter tumour diameter predicted improved OS. CAP-CRT, age⩾65 years, better performance status, CA19.9<46 IU ml(-1) predicted improved OS and PFS in the pre-radiotherapy model. Nine-month PFS was highly predictive of OS.
CONCLUSIONS: CAP-CRT remains the superior regimen. SCALOP showed that patients with CA19.9<46 IU ml(-1) after induction chemotherapy are more likely to benefit from CRT.British Journal of Cancer advance online publication, 4 April 2017; doi:10.1038/bjc.2017.95www.bjcancer.com.
Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.