Lay Summary: CapOx regimen has value in advanced pancreatic cancer.
CapOx regimen has value in advanced pancreatic cancer.
Locally advanced and metastatic pancreatic adenocarcinomas carry a very poor prognosis. In patients treated with the standard palliative treatment gemcitabine (GEM), median survival still remains only 6 months.
Oxaliplatin has the most supporting data when in combination with gemcitabine. There is also very good data for Gemcitabine and oxaliplatin, the GemOx regimen. The XelOx(CapOx) regimen is less well studied.Only phase II studies are available. When used in the second line setting, the Xelox has promising activity in pancreatic cancer.
A comparative phase II study compared three regimen. CapOx, CapGem and GemOx have similar clinical efficacy in advanced PC. Each regimen has a distinct but manageable tolerability profile. A phase II study showed that CAPOX resulted in a slightly inferior efficacy than FUFOX. With respect to PFS, the best estimate of the HR of 1.17 was within the prespecified equivalence range. NCCN represents expert consensus and lists CapeOx as an option for second line therapy (p.17).
The NCCN Panel has stated that combinations of gemcitabine with oxaliplatin, cisplatin, or irinotecan are appropriate for combination therapy. It also lsits CapeOx for second line chemotherapy.
S. Boeck , T. Hoehler , G. Seipelt , R. Mahlberg , A. Wein , A. Hochhaus , H.-P. Boeck , B. Schmid , E. Kettner , M. Stauch , F. Lordick , Y. Ko , M. Geissler , K. Schoppmeyer , G. Kojouharoff , A. Golf , S. Neugebauer , and V. Heinemann Capecitabine plus oxaliplatin (CapOx) versus capecitabine plus gemcitabine (CapGem) versus gemcitabine plus oxaliplatin (mGemOx): final results of a multicenter randomized phase II trial in advanced pancreatic cancer Ann Oncol 19: 340-347, 2008
Xiong HQ, Wolff RA, Hess KR, et al. A phase II trial of oxaliplatin plus capecitabine (xelox) as second line therapy for patients with advanced pancreatic cancer. J Clin Oncol (2006) 24(Suppl):207s. (Abstr 4119).
Y. J. Chua and J. R. Zalcberg Pancreatic cancer–is the wall crumbling? Ann. Onc., July 1, 2008; 19(7): 1224 – 1230.
C. Louvet, R. Labianca, P. Hammel, G. Lledo, M.G. Zampino, T. Andre, A. Zaniboni, M. Ducreux, E. Aitini, J. Taieb, et al.
Gemcitabine in Combination With Oxaliplatin Compared With Gemcitabine Alone in Locally Advanced or Metastatic Pancreatic Cancer: Results of a GERCOR and GISCAD Phase III Trial J. Clin. Oncol., May 20, 2005; 23(15): 3509 – 3516.
Capecitabine plus oxaliplatin (CapOx) versus capecitabine plus gemcitabine (CapGem) versus gemcitabine plus oxaliplatin (mGemOx): final results of a multicenter randomized phase II trial in advanced pancreatic cancer Annals of Oncology. Ann Oncol 19: 340-347, 2008