Pancreatic cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
The selection of a treatment intervention depends largely on the disease progression and the patient's stage of cancer. Chemotherapy may be employed when surgical intervention is not deemed appropriate.
Medical Therapy
- There are five different types of treatment for patients with pancreatic cancer.
- Surgery
- Radiation therapy
- Chemotherapy
- Chemoradiation therapy
- Targeted therapy
- New types of treatment are being tested in clinical trials.
- Biologic therapy
Chemotherapy
In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the US FDA in 1998 after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival clinical trial endpoint. Gemcitabine is administered intravenously on a weekly basis. Addition of oxaliplatin (Gem/Ox) conferred benefit in small trials, but is not yet standard therapy.[1] Fluorouracil (5FU) may also be included.
On the basis of a Canadian led Phase III Randomised Controlled trial involving 569 patients with advanced pancreatic cancer, the US FDA has licensed the use of erlotinib (Tarceva) in combination with gemcitabine as a palliative regimen for pancreatic cancer. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumor response and improved progression-free survival rates. The survival improvement with the combination is on the order of less than four weeks, leading some cancer experts to question the incremental value of adding erlotinib to gemcitabine treatment. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting.[2] A trial of anti-angiogenesis agent bevacizumab (Avastin) as an addition to chemotherapy has shown no improvement in survival of patients with advanced pancreatic cancer. It may cause higher rates of high blood pressure, bleeding in the stomach and intestine, and intestinal perforations.
Nutritional supplements
A phase II clinical trial studying the effect of curcumin on pancreatic cancer was completed in 2007 and the results were published in 2008. The study used eight grams per day in 21 patients and stopped treatment if the tumor size increased. The conclusion of the study was "Oral curcumin is well tolerated and, despite its limited absorption, has biological activity in some patients with pancreatic cancer."[3][4]
Radiation Therapy
The role of radiotherapy as an auxiliary (adjuvant) treatment after potentially curative surgery has been controversial since the 1980s.[5] The European Society for Medical Oncology recommends that adjuvant radiotherapy should only be used for people enrolled in clinical trials.[6] However there is a continuing tendency for clinicians in the US to be more ready to use adjuvant radiotherapy than those in Europe. Many clinical trials have tested a variety of treatment combinations since the 1980s, but have failed to settle the matter conclusively.[5][7]
Radiotherapy may form part of treatment to attempt to shrink a tumor to a resectable state, but its use on unresectable tumors remains controversial as there are conflicting results from clinical trials. The preliminary results of one trial, presented in 2013, "markedly reduced enthusiasm" for its use on locally advanced tumors.[8]
References
- ↑ Demols A, Peeters M, Polus M; et al. (2006). "Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study". Br. J. Cancer. 94 (4): 481–5. doi:10.1038/sj.bjc.6602966. PMID 16434988.
- ↑ FDA approval briefing
- ↑ Dhillon N, Aggarwal BB, Newman RA; et al. (2008). "Phase II trial of curcumin in patients with advanced pancreatic cancer". Clin. Cancer Res. 14 (14): 4491–9. doi:10.1158/1078-0432.CCR-08-0024. PMID 18628464. Unknown parameter
|month=ignored (help) - ↑ De Leon D. "Cancer News and Information: Curcumin Temporarily Slows Pancreatic Cancer". CancerWise.
- ↑ 5.0 5.1
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