Recent developments in palliative chemotherapy for locally advanced and metastatic pancreas cancer
Recent developments in palliative chemotherapy for locally advanced and metastatic pancreas cancer
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DOI：
10.3748/wjg.v16.i6.673
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发表时间：
2010-02-14
影响因子：
4.3
通讯作者：
Rocha-Lima, Caio Max
中科院分区：
文献类型：
--
作者：
Bayraktar, Soley;Bayraktar, Ulas Darda;Rocha-Lima, Caio Max
尽管在其他更常见的胃肠道癌症的治疗方面取得了进展，但在胰腺癌的治疗方面仍未取得重大进展。胰腺癌的死亡人数几乎与每年确诊的人数一样多，这反映了该疾病通常与预后不良有关。直到最近，唯一对生存有影响的治疗方法是手术。在姑息治疗方面，吉西他滨（Gem）已成为晚期胰腺癌的标准治疗方案，因为它在十年前被证明与5-氟尿嘧啶丸相比具有更优越的临床获益反应和生存期。从那时起，临床试验探索了通过固定剂量给药和Gem与其他细胞毒性或生物学“靶向”药物联合使用Gem的药代动力学调节。然而，在小型H期试验中有希望的试验结果并没有转化为晚期疾病中较大的III期随机试验的生存改善。最近有两项试验报告了Gem和卡培他滨联合治疗（英国国家癌症研究所GEMCAP试验）或厄洛替尼（加拿大国家癌症研究所临床试验组PA.3试验）对生存率的适度改善。本文将重点讨论晚期和转移性胰腺癌的全身治疗，总结最近几项临床试验的结果，并讨论其对临床实践的影响。我们还将简要讨论晚期胰腺癌的二线化疗方案。(C) 2010年白石登。版权所有。
In spite of advances made in the management of the other more common cancers of the gastrointestinal tract, significant progress in the treatment of pancreatic cancer remains elusive. Nearly as many deaths occur from pancreatic cancer as are diagnosed each year reflecting the poor prognosis typically associated with this disease. Until recently, the only treatment with an impact on survival was surgery. In the palliative setting, gemcitabine (Gem) has been a standard treatment for advanced pancreatic cancer since it was shown a decade ago to result in a superior clinical benefit response and survival compared with bolus 5-fluorouracil. Since then, clinical trials have explored the pharmacokinetic modulation of Gem by fixed dose administration and the combination of Gem with other cytotoxic or the biologically "targeted" agents. However, promising trial results in small phase H trials have not translated into survival improvements in larger phase III randomized trials in the advanced disease setting. Two trials have recently reported modest survival improvements with the use of combination treatment with Gem and capecitabine (United Kingdom National Cancer Research GEMCAP trial) or erlotinib (National Cancer Institute of Canada Clinical Trials Group PA.3 trial). This review will focus on the use of systemic therapy for advanced and metastatic pancreatic cancer, summarizing the results of several recent clinical trials and discuss their implications for clinical practice. We will also discuss briefly the second-line chemotherapy options for advanced pancreatic cancer. (C) 2010 Baishideng. All rights reserved.