Adjuvant therapy for pancreatic cancer.
Ductal adenocarcinoma of the pancreas is one of the leading causes of cancer death in the UK, Europe and US, with incidence closely paralleling mortality. Until recently, enthusiasm for treating these patients was limited for a number of reasons: the majority of patients undergoing surgery would relapse early, adjuvant treatment was of unproven value and systemic therapy in advanced disease had only a small chance of a short-term benefit. More recently, however, it has become recognised that specialist surgery can improve results and there is evidence that adjuvant chemotherapy has a significant advantage in terms of 5-year survival. In particular adjuvant systemic 5-fluorouracil with folinic acid can result in 5-year survival of < or = 29% (compared with 11% for controls) and adjuvant gemcitabine can improve disease-free survival to 13.4 months from a median of 6.9 months in controls, but not overall survival. In contrast the role of adjuvant chemoradiation in addition to chemotherapy remains unproven and the survival results appear to be inferior to systemic chemotherapy alone. New agents, such as capecitabine and erlotinib, are emerging with some activity in this dismal disease signalling hope for the future.
Aung
Kyaw L
KL
Clatterbridge Centre for Oncology, Bebington, Wirral, Merseyside, CH63 4JY, UK. kyan.aung@ccotrust.nhs.uk
Smith
David B
DB
Neoptolemos
J P
JP
D000964:Antimetabolites, Antineoplastic / Q000493:pharmacokinetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000639:trends; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D047428:Protein Kinase Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors