Frucht Harold, Stevens Peter D., Fogelman David R., Verna Elizabeth C., Chen Johnson, Chabot John A., Fine Robert L.
Curr Treat Options Gastroenterol. 2004 Oct;7(5):343-354. doi: 10.1007/s11938-004-0047-8.
Familiarity with the updated results in genetic screening and work-up presented here is essential to early diagnosis and possible cure. In the metastatic setting, we most frequently begin with the GTX regimen, consisting of Gemcitabine, Taxotere, and Xeloda. The regimen is based on our laboratory data demonstrating a synergistic increase in cell killing of pancreatic cancer cell lines. The combination takes advantage of the selective cell cycle effects of each of the three drugs. In our initial experience, we have seen a response rate of 40% at metastatic sites and 31% at the primary site after nine cycles of GTX. We are now conducting a formal phase II protocol to confirm these results. The median survival of this group of patients (at least 10.4 months) is as long as, or longer than other currently used regimens. In those patients who do not tolerate GTX or progress despite the regimen, we have found that a regimen of the same three drugs, administered on a different schedule, can produce responses. In the neoadjuvant (unresectable) setting, we treat with GTX initially and then follow with radiation; gemcitabine is used as a radiosensitizer during this treatment. An aggressive surgical approach with a team of surgeons were able to resect for cure 12 of the 16 patients who were initially unresectable; one year survival of these 12 was 100%; 2 year survival was 50%. Future work in this disease should focus on targeted agents such as bevacizumab.
熟悉本文中介绍的基因筛查和检查的最新结果对于早期诊断和可能的治愈至关重要。在转移性情况下，我们最常开始使用GTX方案，该方案由吉西他滨、多西他赛和希罗达组成。该方案基于我们的实验室数据，这些数据表明对胰腺癌细胞系的细胞杀伤有协同增加作用。该组合利用了三种药物各自的选择性细胞周期效应。在我们的初步经验中，经过九个周期的GTX治疗后，我们在转移部位的缓解率为40%，在原发部位为31%。我们现在正在进行一项正式的II期方案以证实这些结果。这组患者的中位生存期（至少10.4个月）与目前使用的其他方案一样长或更长。在那些不耐受GTX或尽管使用该方案仍进展的患者中，我们发现以不同给药方案使用相同的三种药物组成的方案可以产生缓解。在新辅助（不可切除）情况下，我们最初用GTX治疗，然后进行放疗；在此治疗期间，吉西他滨用作放射增敏剂。一组外科医生采用积极的手术方法能够为最初不可切除的16名患者中的12名进行根治性切除；这12名患者的一年生存率为100%；两年生存率为50%。该疾病未来的研究应集中在诸如贝伐单抗等靶向药物上。
