Halfdanarson TR, et al. - In the North Central Cancer Treatment Group (now part of Alliance for Clinical Trials in Oncology) trial N064B, researchers performed a comparison of gemcitabine plus erlotinib vs gemcitabine plus combined epidermal growth factor receptor (EGFR) inhibition with erlotinib and panitumumab in patients with untreated, metastatic pancreatic adenocarcinoma. They randomized 92 patients to either gemcitabine 1,000 mg/m²on days 1, 8, and 15 of a 28-day cycle with erlotinib 100 mg po daily (arm A) or the same combination with the addition of panitumumab 4 mg/kg on days 1 and 15 of a 28-day cycle (arm B). They observed significantly prolonged overall survival in patients with advanced adenocarcinoma of the pancreas after dual EGFR-directed therapy, but with substantially increased toxicities. As single-agent gemcitabine is no longer considered an appropriate therapy for otherwise fit patients with metastatic pancreatic cancer, they do not recommend dual EGFR-directed therapy in combination with gemcitabine alone for further study.