Gounaris Ioannis, Zaki Kamarul, Corrie Pippa
Oncology Centre, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
JOP. 2010 Mar 5;11(2):113-23.
Pancreatic cancer is noteworthy in that the number of patients dying from the disease is roughly equal to the number diagnosed. For more than a decade, gemcitabine has constituted the standard of care for the palliative treatment of the majority of patients who present with metastatic or relapsed disease, although the survival gains are limited. Despite a median survival of less than 6 months, there is a significant proportion of advanced pancreatic cancer patients who progress on gemcitabine that remains fit and these patients are candidates for second-line treatment.
The OVID MEDLINE database was searched from 1950 to present using the MeSH terms "pancreatic neoplasms", "drug treatment" and "gemcitabine". After excluding non-relevant results, 31 published studies were identified. These results were supplemented by searching the last three (2007-2009) American Society of Clinical Oncology (ASCO) Proceedings of Annual Meetings for studies published only in abstract form and reviewing reference lists of published articles.
The evidence for second line treatments of metastatic pancreatic cancer consists mostly of single arm, small phase II studies. Oxaliplatin-fluoropyrimidine combinations appear promising and have shown increased survival compared to best supportive care. As the molecular pathways governing pancreatic cancer are unravelled, novel targeted therapies may offer the greatest promise for this disease either given alone, combined with one another, or with cytotoxic agents. The need for further, collaborative research is emphasised.
胰腺癌值得关注之处在于，死于该疾病的患者数量与被诊断出的患者数量大致相等。十多年来，吉西他滨一直是大多数出现转移性或复发性疾病患者姑息治疗的标准疗法，尽管生存获益有限。尽管中位生存期不到6个月，但仍有相当一部分晚期胰腺癌患者在使用吉西他滨治疗时病情进展，且身体状况尚可，这些患者是二线治疗的候选对象。
使用医学主题词“胰腺肿瘤”“药物治疗”和“吉西他滨”对1950年至今的OVID MEDLINE数据库进行检索。排除不相关结果后，确定了31项已发表的研究。通过检索美国临床肿瘤学会（ASCO）最近三届（2007 - 2009年）年会仅以摘要形式发表的研究，并查阅已发表文章的参考文献列表，对这些结果进行了补充。
转移性胰腺癌二线治疗的证据主要来自单臂、小型II期研究。奥沙利铂 - 氟嘧啶联合方案似乎很有前景，与最佳支持治疗相比，已显示出生存期延长。随着控制胰腺癌的分子途径被逐步揭示，新型靶向治疗单独使用、相互联合或与细胞毒性药物联合使用，可能为该疾病带来最大的希望。强调了进一步开展合作研究的必要性。
