The results of a study investigating the use of a new triple regimen, irinotecan, cisplatin and mitomycin (IPM), in patients with inoperable gastro-oesophageal and pancreatic cancer has been published in the latest issue of the British Journal of Cancer.
Patients received a 2-weekly regimen, they received 6 mg m2 of mitomycin on Day 1 only, with 100 mg m2 of irinotecan and 40 mg m2 of cisplatin on Days 1 and 15 of the 28 day cycle.
A total of 6 cycles of chemotherapy were planned, with omission of mitomycin for the last 2 cycles. Twenty-six out of 31 patients with gastro-oesophageal cancer and 12 out of 14 patients with pancreatic cancer were evaluable for response.
The researchers found, ‘the overall response rates for patients with gastro-oesophageal cancer was 42%, with a median survival of 9.5 months. In patients with pancreatic cancer, the overall response rate was 42% with a median survival of 8 months. There was a statistically significant increase in survival between those patients who achieved a stable disease response and those who achieved either a partial response or complete response. The toxicity profiles for both cancers were virtually identical. There were five treatment-related deaths, and a high admission rate (42%).’
Researchers concluded, ‘This study has demonstrated the efficacy and potential of IPM, a non-fluorouracil-based treatment, in upper gastro-oesophageal and pancreatic cancers. Patients with pancreas cancer had a significant improvement in the median survival if a response to IPM was achieved. The treatment has, however, resulted in a high toxicity rate: a treatment-related death rate of 11%, and an admission rate of 42%. Future adaptations to this regimen should take into account the difficulties experienced, and reduce the dose of irinotecan to 70 mg m2, and limit the number of cycles to four. Other considerations should also be into exploring the addition of 5FU in this regimen. To maintain the important outpatient element, 5FU could be administered in its oral format, capecitabine.’