Brunet R, Fonck M
Institut Bergonié, Bordeaux, France.
Rev Med Interne. 1999 Sep;20(9):816-20. doi: 10.1016/s0248-8663(00)88691-9.
Pancreatic cancer is one of the most common tumor of the gastrointestinal tract.
Because this malignancy is usually diagnosed at an advanced stage, its prognosis is poor, and patients are generally considered incurable at diagnosis. The traditional palliative approach to management of this tumor is chemotherapy. The most widely used agent is 5-FU, alone or in combination. Benefits of the treatment are still poor: the overall survival time rarely exceeds 5 months, and no study has shown a response rate greater than 20%.
Gemcitabine, a new antinucleoside agent, has led to promising results, as several phase II and III studies have demonstrated an increase in survival as compared with 5-FU, the overall 1-year survival rates being 18% and 2%, respectively (p < 0.002). Furthermore, even if only discrete results in terms of objective response rate have been achieved, gemcitabine decreases disease-related symptoms, thus benefiting to the patient's quality of life. The concept of clinical benefit therefore appears to be an important judgement criteria in the assessment of chemotherapy efficacy, and will certainly be extended to other malignant neoplasms.
胰腺癌是胃肠道最常见的肿瘤之一。
由于这种恶性肿瘤通常在晚期才被诊断出来，其预后很差，患者在确诊时通常被认为无法治愈。治疗这种肿瘤的传统姑息方法是化疗。最广泛使用的药物是5-氟尿嘧啶（5-FU），单独使用或联合使用。治疗效果仍然不佳：总体生存时间很少超过5个月，而且没有研究显示缓解率超过20%。
吉西他滨，一种新型抗核苷药物，已取得了令人鼓舞的结果，因为多项II期和III期研究表明，与5-FU相比，其生存期有所延长，总体1年生存率分别为18%和2%（p < 0.002）。此外，即使在客观缓解率方面仅取得了有限的结果，但吉西他滨可减轻与疾病相关的症状，从而改善患者的生活质量。因此，临床获益的概念似乎是评估化疗疗效的一个重要判断标准，并且肯定会扩展到其他恶性肿瘤。
