Prospective Study on Warfarin and Regional Chemotherapy
in Patients with Pancreatic Carcinoma
Full Article (PDF file)
Wes Nakchbandi1, Herwart Müller1, Manfred
V. Singer2, J. Matthias Löhr2, Inaam A.
1) Department of Oncologic Surgery, Carl von Hess Hospital,
2) Department of Medicine II, University of Heidelberg at Mannheim;
3) Max-Planck Institute for Biochemistry and University of Heidelberg,
Aims: 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.
Results: 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
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.
Pancreatic carcinoma - warfarin - regional chemotherapy.