Adjuvant treatment strategies for pancreatic cancer.
Pancreatic cancer is a difficult and unsolved surgical problem. It remains one of the top five causes of cancer-related deaths and has the lowest 5-year survival of any cancer, largely due to late diagnosis, low resection rates, and local recurrence. Clinical trials examining the optimal timing and delivery of adjuvant therapies for pancreatic cancer have yielded controversial results. Although most experts agree that the addition of chemotherapy has survival benefit in patients with resectable pancreatic cancer, there is no consensus regarding the optimal therapeutic agents, timing (neoadjuvant versus adjuvant), and the addition of radiation therapy to the treatment regimen. Multiple phase III trials are in progress in efforts to examine these issues. Additionally, exciting progress has been made with novel chemotherapeutic combinations, and alternative treatment modalities including interferon-alpha, immunotherapy, and pancreatic cancer stem cells. Given the high failure pattern after surgical resection, with more than half of patients developing locoregional recurrence, all patients undergoing pancreaticoduodenectomy are candidates for adjuvant therapy.
Newman
Erika A
EA
Section of Gastrointestinal Surgery, Department of Surgery, The University of Michigan Medical Center, Ann Arbor, Michigan 48108, USA.
Simeone
Diane M
DM
Mulholland
Michael W
MW
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003952:Diagnostic Imaging; D006801:Humans; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine