Adriamycin, BCNU, ftorafur chemotherapy of pancreatic and biliary tract cancer

Twenty‐six evaluable patients with disseminated or locally unresectable pancreatic or biliary tract carcinoma received Ftorafur (4 g/m² iv day 1 and 22 and 2 g/m² iv day 4 and 26), Adriamycin (60 mg/m² IV day 1 and 45 mg/m² iv day 22) and BCNU (150 mg/m² iv day 1) combination chemotherapy (FAB) repeated at 6–8 week intervals. Two (29%) complete and one (14%) partial remissions were observed in 7 patients with biliary carcinoma while 5 of 19 (26%) patients with pancreatic carcinoma achieved partial remissions. Median survival for responding patients was ∼11 months (range 7–16+) with median survivals of about 6 months (p < 0.05) and about 3 months (p < 0.05) for patients with stable and progressive disease. Major drug toxicity was myelosuppression with median lowest granulocyte counts of 1,000/μl and platelet counts of 88,000/μl. Approximately 25% of patients required antibiotic therapy for fever of unknown origin or documented infections. Other tolerable drug toxicities included nausea, vomiting and mucositis. The FAB regimen appears quite promising in biliary tract cancer and has efficacy in pancreatic carcinoma that warrants further clinical trials. Because of myelotoxicity observed with this regimen we now recommend a BCNU starting dose of 100 mg/m² instead of 150 mg/m².