title: Systemic and adjuvant therapy for patients with pancreatic carcinoma.
abstract: BACKGROUND
  Pancreatic cancer is a highly lethal disease with < or = 5% of patients surviving 5 years. There is no curative therapy for patients who cannot be surgically resected. Chemotherapy and radiation therapy can provide palliation but have not had a significant impact on 5-year survival.
  
  
  METHODS
  Newer approaches for improving the survival of patients with pancreatic cancer integrating chemotherapy, radiation therapy, and surgery are being evaluated. New chemotherapeutic agents (e.g., gemcitabine, camptothecins, taxanes, thymydilate synthase inhibitors, and fluorouracil-related compounds) are being studied alone and in combination with each other or different agents (e.g., trimetrexate or platinum-related compounds).
  
  
  RESULTS
  Increased knowledge about the biology of pancreatic cancer (including high frequency of ras and p53 mutations in neoplastic cells or the expression of a number of growth factor receptors on the cell surface) has lead to preclinical evaluation of novel approaches attempting to specifically target these. These novel approaches include gene therapy, vaccines, and antisense oligonucleotides targeted to genes important for proliferation or survival of pancreatic cancer cells.
  
  
  CONCLUSIONS
  Continued development of new approaches is needed to improve the treatment and survival of patients with pancreatic cancer.
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Clark
authors.forename: A S
authors.initials: AS
authors.lastname: Glicksman
authors.forename: H J
authors.initials: HJ
authors.lastname: Wanebo
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D010190:Pancreatic Neoplasms / Q000628:therapy*; D018714:Radiotherapy, Adjuvant