- J Gastrointestin Liver Dis. 2008 Sep;17(3):285-90.
Prospective study on warfarin and regional chemotherapy in patients with pancreatic carcinoma.
Nakchbandi W, Müller H, Singer MV, Lohr JM, Nakchbandi IA.
Department of Oncologic Surgery, Carl von Hess Hospital, Hammelburg, Germany.
The aim is to prospectively examine the effect of regional gemcitabine
and mitomycin-C with systemic gemcitabine together with warfarin in
patients with inoperable pancreatic carcinoma, and compare the effect
to systemic gemcitabine alone.
METHODS: Seventeen patients received
1.25 mg of warfarin daily, gemcitabine 800 mg/m2 on day 1 and
mitomycin-C 8 mg/m2 on day 2 regionally and gemcitabine 800 mg/m2 on
day 14 peripherally. The cycle was repeated every 4 weeks.
Median survival since presentation was 6.8 months, while median total
survival was 9.6 months. Excluding the 3 patients who died before
receiving any therapy, the median survival since presentation resulted
in 10.7 months and the median total survival, 12.7 months. One patient
developed bleeding that required transfusion and 2 patients developed
anemia (Grades III/IV). Comparing these data to historical controls of
large cohorts supports the notion that this regimen offers a viable
alternative to systemic gemcitabine alone.
CONCLUSION: A regimen
consisting of regional gemcitabine and mitomycin-C with systemic
gemcitabine and low-dose warfarin compares favorably to the gold
standard of systemic gemcitabine. These data suggest the feasibility of
a large prospective study on the use of warfarin and combined regional
and systemic chemotherapy in patients with pancreatic carcinoma.