Background: This phase III trial compared the efficacy and safety of gemcitabine plus capecitabine (GemCap) versus single-agent gemcitabine (Gem) in advanced pancreatic cancer as first-line chemotherapy. Methods: A total of 214 advanced pancreatic cancer patients were enrolled from 16 hospitals in South Korea between 2007 and 2011. Patients were randomly assigned to receive GemCap (oral capecitabine 1660mg/m2 plus Gem 1000mg/m2 by 30-minute intravenous infusion weekly for 3 weeks followed by a 1-week break every 4 weeks) or Gem (by 30-minute intravenous infusion weekly for 3 weeks every 4 weeks). Results: Median overall survival (OS) time, the primary end point, was 10.3 and 7.5 months in the GemCap and Gem arms, respectively (P=0.06). Progression-free survival was 6.2 and 5.3 months in the GemCap and Gem arms, respectively (P=0.08). GemCap significantly improved overall response rate compared with Gem alone (43.7% vs 17.6%; P=0.001). Overall frequency of grade 3 or 4 toxicities was similar in each group. Neutropenia was the most frequent grade 3 or 4 toxicity in both groups. Conclusion: GemCap failed to improve OS at a statistically significant level compared to Gem treatment. This study showed a trend toward improved OS compared to Gem alone. GemCap and Gem both exhibited similar safety profiles. Abbreviations: BSA = body surface area, CA 19-9 = carbohydrate antigen 19-9, Cap = capecitabine, CEA = chorioembryonic antigen, CR = complete responses, CT = computed tomography, ECOG = Eastern Cooperative Oncology Group, FOLFIRINOX = fluorouracil, irinotecan, oxaliplatin, and leucovorin, FU = fluorouracil, Gem = gemcitabine, GemCap = gemcitabine plus capecitabine, HR = hazard ratio, MRI = magnetic resonance imaging, ORR = objective response rate, OS = overall survival, PET = positron emission tomography, PFS = progression-free survival, PR = partial responses, RECIST = response evaluation criteria in solid tumors.
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