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To evaluate the efficacy and safety of chemotherapy for unresectable stage IVb pancreatic cancer.

Patients and method

We retrospectively reviewed 48 patients who received chemotherapy for unresectable stage IVb pancreatic cancer in our hospital from March 2005 to October 2011. The characteristics of the 48 cases were as follows: male, 25; female, 23; median age, 67 years; range, 44–83 years. ECOG performance status 0/1/2 = 6/40/2. Primary tumor arose in the head, body, tail and body to tail in 24, 13, 10 and 1, respectively. As a first-line chemotherapy, 36 patients were treated with gemcitabine (GEM) alone, 8 patients with S1 alone and 4 patients with both GEM and S1 (GEM/S1). In the GEM monotherapy, patients received GEM (1000 mg/m2) intravenously on days 1, 8 and 15, repeated every 28 days. In the S1 monotherapy, patients received S1 (80 mg/m2) orally from days 1 to 28, repeated every 42 days. In the GEM/S1 therapy, patients received GEM (1000 mg/m2) intravenously on days 1 and 8, and S1 (80 mg/m2) orally from days 1 to 14, repeated every 21 days. We evaluated the response rate, median survival time (MST) and adverse events. The Kaplan–Meier curves were used for statistical analysis.


The response rate and disease control rate was 2.8 and 47.2% in GEM monotherapy, 12.5 and 50% in S1 monotherapy, and 50 and 50% in GEM/S1 therapy, respectively. MST was 8.4 months in GEM monotherapy, 7.8 months in S1 monotherapy, 4.0 months in GEM/S1 therapy, and there were no significant differences among these three therapies. Grade 3 toxicities were observed in GEM monotherapy (leukopenia, seven patients; neutropenia, five patients; thrombocytopenia, one patient) and in GEM/S1 therapy (neutropenia, one patient; appetite loss, one patient).


Although each regimen was safe and yield the high disease control rate for stage IVb pancreatic cancer, further evaluation how to choose the regimen as a first-line therapy is needed.

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