A Phase II Randomized Study of Induction Chemotherapy Followed by Concurrent Chemo-radiotherapy in Locally Advanced Pancreatic Cancer
Patients should be randomized to two study arms stratified by resectability status
(borderline resectable and unresectable) after enrollment. Eligible patients will be
randomly assigned on a 1:1 basis to either of two study groups, using a central
randomization procedure with stratification according to NCCN criteria of resectability.
After randomization, induction chemotherapy (ICT) will be administered for 3 cycles ( 3
months). Patients who have radiological evidence of distant dissemination will be shifted to
salvage chemotherapy. Patients who have responsive, stable disease as well as those with
localized progressive disease after ICT will receive concurrent chemoradiotherapy (CCRT) 3-4
weeks after the last dose of ICT. Surgical evaluation will be performed 4-6 weeks after the
completion of CCRT. Patients who have respectable disease will undergo surgical resection.
Postoperative adjuvant chemotherapy for 3 cycles ( 3 months) will be given for those who are
considered to have curative resection. Patients who still have unresectable disease or
non-curative resection will receive systemic chemotherapy till disease progression or
For Arm 1, ICT with gemcitabine ( fixed rate of 10mg/m2/min, 1000mg/m2 on day 1,8,15 every
28 days/cycle) will be administered on a 3-week-on-one-week-off weekly basis. For Arm 2, ICT
with GOFL ( 800mg/m2 gemcitabine at a fixed rate of 10mg/m2/min followed by a 2-hour
oxaliplatin 85mg/m2 and then a 48-hour 3000mg/m2 5-FU and 150 mg/m2 leucovorin on day 1 and
15 every 28 days/cycle) will be given biweekly.
After three 3 cycles of ICT, patients without distant metastasis will be given CCRT with
gemcitabine 400mg/m2 2 hrs before RT on day1,8,15,22,29,36. Radiation will be given 180cGy
per day, 5 days a week for 28 fractions to totally 5040cGy.
If complete surgical resection is feasible, optimal surgery will be performed 4-6 weeks
after CCRT. If complete surgical resection is impossible, biopsy with or without bypass
surgery may be performed. Patients who have curative surgical resection will receive
additional 6 cycles ( 6 months) of adjuvant chemotherapy ( Arm1, gemcitabine alone; Arm 2,
GOFL) within 4 weeks after surgery and then followed up until tumor progression. Patients
who are not feasible for curative resection, will receive continued chemotherapy (Arm1,
gemcitabine alone; Arm2, GOFL) 3-4 weeks after CCRT complete. The regimen will continue till
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
The primary end point is to evaluate the time to progression after gemcitabine alone versus Gemcitabine-based combination induction chemotherapy followed by concurrent chemoradiotherapy in locally advanced pancreatic cancer.
Pin-Wen Lin, M.D
National Cheng-Kung University Hospital
Taiwan: Department of Health