Metastatic pancreatic cancer 2008: Is the glass less empty?
Metastatic pancreatic cancer 2008: Is the glass less empty?
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DOI：
10.1634/theoncologist.2007-0181
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发表时间：
2008-05-01
期刊：
影响因子：
5.8
通讯作者：
Kozuch, Peter
中科院分区：
文献类型：
--
作者：
Nieto, Jacqueline;Grossbard, Michael L.;Kozuch, Peter
胰腺癌是美国成人癌症死亡的第四大常见原因。胰腺癌的高死亡率是由于诊断时转移性疾病的高发生率、临床病程往往是暴发性的以及缺乏足够的全身治疗而造成的。不幸的是，只有 5%-25% 的患者患有适合切除的肿瘤。对于可手术的胰腺癌，接受吉西他滨辅助治疗的患者切除后的中位无病生存期为 13.4 个月，而未经治疗的患者为 6.9 个月。较高比例的患者出现转移性疾病 (40%-45%) 或局部晚期疾病 (40%)，中位生存时间分别为 3-6 个月或 8-12 个月。转移性胰腺癌的治疗缺乏显着的临床进展，这仍然是肿瘤内科最令人失望的问题之一。过去十年的挫败感导致监管机构、研究人员和执业肿瘤学家逐渐降低了对临床试验解释的标准/期望。其中两个更重要的例子包括吉西他滨联合厄洛替尼的批准以及利用无进展生存优势来捍卫吉西他滨联合奥沙利铂的使用。鉴于全身抗肿瘤药物的边际效益，包含其他姑息治疗策略的学术综述将有助于肿瘤学家优化胰腺癌患者的护理。本文探讨了支持姑息治疗在转移性胰腺癌中发挥作用的现有证据，描述了新型化疗药物和分子靶向药物的最新进展，并探讨了未来的研究设计。
Pancreatic cancer is the fourth most common cause of adult cancer death in the U. S. The high mortality rate from pancreatic cancer is a result of the high incidence of metastatic disease at the time of diagnosis, an often fulminant clinical course, and the lack of adequate systemic therapies. Unfortunately, only 5%-25% of patients present with tumors amenable to resection. The median disease-free survival interval following resection for operable pancreatic cancer is 13.4 months for patients treated with adjuvant gemcitabine and 6.9 months for untreated patients. A much higher percentage of patients present with metastatic disease (40%-45%) or locally advanced disease ( 40%), and have median survival times of 3-6 months or 8-12 months, respectively. The frustrating lack of significant clinical advancements in the treatment of metastatic pancreatic cancer remains one of medical oncology's biggest disappointments. The past decade-long frustration has resulted in regulators, investigators, and practicing oncologists gradually lowering their standards/expectations with regard to interpreting clinical trials. Two of the more important examples of this include the approval of gemcitabine plus erlotinib and the use of a progression-free survival advantage to defend the use of gemcitabine plus oxaliplatin. Given the marginal benefit of systemic antineoplastics, a scholarly review inclusive of other palliative strategies will help oncologists optimize the care of pancreatic cancer patients. This article examines the existing evidence in support of a role for palliative therapy in metastatic pancreatic cancer, describes recent developments with newer chemotherapeutic and molecular-targeted agents, and explores future study designs.