Beyond first-line chemotherapy for advanced pancreatic cancer: An expanding array of therapeutic options?
Beyond first-line chemotherapy for advanced pancreatic cancer: An expanding array of therapeutic options?
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DOI：
10.3748/wjg.v20.i9.2224
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发表时间：
2014-03-07
影响因子：
4.3
通讯作者：
Ko, Andrew H.
中科院分区：
文献类型：
--
作者：
Walker, Evan J.;Ko, Andrew H.
虽然现在有越来越多的治疗方案可用于局部晚期或转移性胰腺癌的一线治疗，但二线及以上治疗的最佳选择还没有明确的定义。尽管主要是在小型单臂或回顾性研究的背景下，各种细胞毒剂，无论是单独的还是联合的，都进行了评估。大多数方案的中位无进展存活率在2-4个月之间，总存活率在4-8个月之间，这突显了接受这种治疗的患者预后非常差。与此同时，在这种化疗难治的环境中研究的靶向治疗产生了更糟糕的疗效。在这篇文章中，我们回顾了治疗难治性疾病的临床证据，主要是在基于吉西他滨的一线化疗中取得进展的患者。在这个过程中，我们强调了迄今为止可用数据的局限性以及在这种挽救环境下设计适当的临床试验的一些挑战，包括如何在缺乏成熟的参考标准的情况下选择适当的对照药物，以及尽可能将预测性生物标记物和生活质量测量纳入研究设计的重要性。(C)2014年白石登出版集团有限公司。版权所有。
While an increasing number of therapeutic options are now available for the first-line treatment of locally advanced or metastatic pancreatic cancer, the optimal choice for treatment in the second-line setting and beyond is less well defined. A variety of cytotoxic agents, either alone or in combination, have been evaluated, although primarily in the context of small single-arm or retrospective studies. Most regimens have been associated with median progression-free survival rates in the range of 2-4 mo and overall survival rates between 4-8 mo, highlighting the very poor prognosis of patients who are candidates for such treatment. Targeted therapies studied in this chemotherapy-refractory setting, meanwhile, have produced even worse efficacy results. In the current article, we review the clinical evidence for treatment of refractory disease, primarily in patients who have progressed on front-line gemcitabine-based chemotherapy. In the process, we highlight the limitations of the available data to date as well as some of the challenges in designing appropriate clinical trials in this salvage setting, including how to select an appropriate control arm given the absence of a well-established reference standard, and the importance of incorporating predictive biomarkers and quality of life measures whenever possible into study design. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.