Pancreatic cancer - historical

The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main pancreatic cancer page for current regimens.

3 regimens on this page 3 variants on this page

Induction therapy for locally advanced disease, unresectable

FLEC

FLEC: Fluorouracil, Leucovorin (Folinic acid), Epirubicin, Carboplatin

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Cantore et al. 2004	1997-2001	Phase 3 (E-esc)	Gemcitabine	Seems to have superior OS (primary endpoint)

Chemotherapy

• Fluorouracil (5-FU) 1000 mg/m² IA bolus once on day 1
• Leucovorin (Folinic acid) 100 mg/m² IA bolus once on day 1
• Epirubicin (Ellence) 60 mg/m² IA bolus once on day 1
• Carboplatin (Paraplatin) 300 mg/m² IA bolus once on day 1

21-day cycle for 3 cycles

References

1. Cantore M, Fiorentini G, Luppi G, Rosati G, Caudana R, Piazza E, Comella G, Ceravolo C, Miserocchi L, Mambrini A, Del Freo A, Zamagni D, Rabbi C, Marangolo M. Gemcitabine versus FLEC regimen given intra-arterially to patients with unresectable pancreatic cancer: a prospective, randomized phase III trial of the Italian Society for Integrated Locoregional Therapy in Oncology. J Chemother. 2004 Dec;16(6):589-94. link to original article contains dosing details in abstract PubMed

Metastatic disease, first-line

PEFG

PEFG: Platinol (Cisplatin), Epirubicin, Fluorouracil, Gemcitabine

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Reni et al. 2005	2000-2003	Phase 3 (E-esc)	Gemcitabine	Superior PFS4 (primary endpoint) PFS4: 60% vs 28% (HR 0.46, 95% CI 0.26-0.79)

Chemotherapy

• Cisplatin (Platinol) 40 mg/m² IV once on day 1
• Epirubicin (Ellence) 40 mg/m² IV once on day 1
• Fluorouracil (5-FU) 200 mg/m²/day IV continuous infusion over 28 days, started on day 1 (total dose per cycle: 5600 mg/m²)
• Gemcitabine (Gemzar) 600 mg/m² IV over 60 minutes once per day on days 1 & 8

28-day cycles

References

1. Reni M, Cordio S, Milandri C, Passoni P, Bonetto E, Oliani C, Luppi G, Nicoletti R, Galli L, Bordonaro R, Passardi A, Zerbi A, Balzano G, Aldrighetti L, Staudacher C, Villa E, Di Carlo V. Gemcitabine versus cisplatin, epirubicin, fluorouracil, and gemcitabine in advanced pancreatic cancer: a randomised controlled multicentre phase III trial. Lancet Oncol. 2005 Jun;6(6):369-76. link to original article contains dosing details in abstract PubMed

Metastatic disease, all lines of therapy

SMF

SMF: Streptozotocin, Mitomycin, 5-Fluorouracil

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Kelsen et al. 1991	1987-1989	Phase 3 (C)	CAC	Superior OS

Chemotherapy

• Streptozocin (Zanosar) 1000 mg/m² IV once per day on days 1, 8, 29, 36
• Mitomycin (Mutamycin) 10 mg/m² IV once on day 1
• Fluorouracil (5-FU) 600 mg/m² IV once per day on days 1, 8, 29, 36

8-week cycles

References

1. Kelsen D, Hudis C, Niedzwiecki D, Dougherty J, Casper E, Botet J, Vinciguerra V, Rosenbluth R. A phase III comparison trial of streptozotocin, mitomycin, and 5-fluorouracil with cisplatin, cytosine arabinoside, and caffeine in patients with advanced pancreatic carcinoma. Cancer. 1991 Sep 1;68(5):965-9. link to original article contains dosing details in manuscript PubMed