Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States.
World J Gastroenterol. 2010 Feb 14;16(6):673-82. doi: 10.3748/wjg.v16.i6.673.
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 II 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.
尽管在胃肠道其他更常见癌症的治疗方面取得了进展，但在胰腺癌的治疗方面仍难以取得显著进展。每年因胰腺癌而死亡的人数与被诊断出的人数相当，反映了这种疾病通常与预后不良相关。直到最近，唯一对生存有影响的治疗方法是手术。在姑息治疗中，吉西他滨（Gem）自十年前被证明与氟尿嘧啶相比可产生更好的临床获益反应和生存获益以来，一直是晚期胰腺癌的标准治疗方法。此后，临床试验已经探讨了通过固定剂量给药来调节 Gem 的药代动力学，并将 Gem 与其他细胞毒性药物或生物“靶向”药物联合使用。然而，在小型 II 期试验中取得的有前途的试验结果并未转化为在晚期疾病情况下的更大规模 III 期随机试验中的生存改善。最近有两项试验报告称，使用 Gem 和卡培他滨（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）联合治疗可适度改善生存。这篇综述将重点关注晚期和转移性胰腺癌的系统治疗，总结了几项最近临床试验的结果，并讨论了它们对临床实践的意义。我们还将简要讨论晚期胰腺癌的二线化疗选择。
