intra-arterial versus intravenous chemotherapy for locally advanced pancreatic cancer

Conditions: Carcinoma, Pancreatic

Summary: this study aims to explore the efficacy and safety of intra- arterial infusion of gemcitabine and oxaliplatin in locally advanced pancreatic cancer. this protocol is overseen by the fudan university institutional review board which has federal wide assurance through the u.s. department of health \& human services (approved: april 25, 2002).

primary outcome measures: to compare the overall survival (os) in patients with locally advanced pancreatic cancer treated with transcatheter arterial infusion (tai) of chemotherapeutics or systemic delivered chemotherapy. secondary outcome measures: to compare the progression free survival (pfs), objective response rate (orr), quality of life (qol), and adverse effects of treating locally advanced pancreatic cancer patients with tai or systemic chemotherapy. exploratory outcome measures: to evaluate the correlation between prognosis and expression of serum micrornas of the patients.

Eligibility criteria:
inclusion criteria: * histologically/cytologically confirmed unresectable locally advanced pancreatic adenocarcinoma. * measurable disease by recist criteria must be present. * karnofsky performance status ≥ 70 * patients with adequate organ functions reflected by the laboratory criteria below: granulocytes ≥ 1,500/ul hemoglobin ≥ 8.0 gm/dl platelets ≥ 100,000/ul serum creatinine \< 2.0 mg/dl bilirubin \< 1.5 mg/dl sgpt \< 2.5 x normal alk phos \< 2.5 x normal * prior local therapy, e.g., radiation, is allowed provided that at least 4 weeks washout time is given. * patients with jaundice must have a biliary drainage decompression operation before recruitment. * patients must not be pregnant. serum beta-hcg will be checked in all premenopausal patients. * ability to understand and the willingness to sign a written informed consent. exclusion criteria: * subject with metastatic disease. * prior treatment with systemic chemotherapy. * known allergies to the gemcitabine, oxaliplatin or iodine contrast agent. * subject with child-pugh grade class c hepatic impairment, active gastrointestinal bleeding, severe coagulation disorder that could not be corrected，or other contraindication for transcatheter infusion. * untreated or uncontrolled deep vein thrombosis, arterial thrombosis of lower extremity, or aneurysm. * concurrent infection requiring intravenous antibiotics. * skin injury or infection of groin area, or other situation that not appropriate for femoral artery puncture. * other serious illness or condition including cardiac disease including congestive heart failure (new york heart association classification iii or iv), active hiv infection/hiv disease, psychiatric disorders. * known central nervous system involvement and leptomeningeal disease * subject with previous or concurrent cancer that is distinct in primary site or histology from pancreatic adenocarcinoma except cervical carcinoma in situ, non-melanoma carcinoma of the skin or in situ carcinoma of the bladder. any cancer curatively treated greater than 3 years prior to entry is permitted. * pregnant or lactating women.

Keywords: transcatheter arterial infusion randomized controlled trial chemotherapy