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Gemcitabine plus 5-FU, cisplatin and epirubicin (PEFG) — Some of the most impressive activity has been noted with the combination of gemcitabine, 5-FU, cisplatin, and epirubicin (PEFG, show table 1) administered every 28 days. In one study of 49 patients with metastatic pancreatic cancer, the objective response rate was 58 percent, clinical benefit was noted in 78 percent, the median TTP was 7.5 months, and survival was 11 months . Grade 3 to 4 neutropenia complicated one-half of all delivered cycles, but nonhematologic toxicity, particularly gastrointestinal toxicity was infrequent.
The PEFG regimen (show table 1) was compared to gemcitabine alone (1000 mg/m2 weekly for seven of eight weeks, then three of every four weeks) in 104 patients with advanced pancreatic cancer . In a preliminary report, PEFG was associated with a significantly higher response rate (40 versus 8.5 percent), and four month PFS (60 versus 28 percent), but there was only a trend towards improved one-year survival (38 versus 22 percent, p = 0.06).
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