Furuse Junji, Ishii Hiroshi, Nakachi Kohei, Suzuki Eiichiro, Shimizu Satoshi
Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East.
Gan To Kagaku Ryoho. 2007 Jul;34(7):997-1001.
The early diagnosis of pancreatic cancer is difficult because of the lack of specific early symptoms,and surgery with curative intent can be performed in only 20% of patients. Chemotherapy for unresectable pancreatic cancer has been advancing ever since gemcitabine (GEM) was confirmed to provide a survival advantage in patients with advanced pancreatic cancer. For more than 20 years, the standard treatment for locally advanced diseases has been chemoradiotherapy using 5-FU, but more effective chemotherapy regimens are required. New standard treatments for locally advanced pancreatic cancer, including GEM chemotherapy and chemoradiotherapy using new agents, should be investigated. Several randomized clinical trials comparing GEM-based chemotherapy and GEM alone for the treatment of unresectable pancreatic cancer have been conducted, but a new standard chemotherapy regimen superior to GEM alone has not established. In Japan, phase II studies of S-1 or a combination of GEM and S-1 have produced promising survival rates, and a large phase III study using GEM and S-1 is necessary to establish the standard chemotherapy. Furthermore, second-line chemotherapy regimens for use after GEM chemotherapy should be investigated to improve the survival of patients with advanced pancreatic cancer.
由于缺乏特异性早期症状，胰腺癌的早期诊断较为困难，只有20%的患者能够接受根治性手术。自从吉西他滨（GEM）被证实能使晚期胰腺癌患者的生存期延长以来，不可切除胰腺癌的化疗一直在不断发展。20多年来，局部晚期疾病的标准治疗方法一直是使用5-氟尿嘧啶进行放化疗，但仍需要更有效的化疗方案。应研究包括GEM化疗和使用新药物的放化疗在内的局部晚期胰腺癌的新标准治疗方法。已经进行了几项比较基于GEM的化疗与单纯GEM治疗不可切除胰腺癌的随机临床试验，但尚未确立优于单纯GEM的新标准化疗方案。在日本，S-1或GEM与S-1联合使用的II期研究取得了令人鼓舞的生存率，有必要开展一项使用GEM和S-1的大型III期研究来确立标准化疗方案。此外，应研究GEM化疗后使用的二线化疗方案，以提高晚期胰腺癌患者的生存率。
