Sharma Charu, Horowitz David, Chabot John, Saif Muhammad Wasif
Columbia University College of Physicians and Surgeons, New York, NY, USA.
JOP. 2011 Jul 8;12(4):343-6.
Strong evidence exists for the use of adjuvant chemotherapy following surgical resection in pancreatic cancer, whereas the role of adjuvant chemoradiotherapy remains controversial. The optimal time to initiate adjuvant therapy has yet to be elucidated, but is usually started 2-10 weeks following resection. First line adjuvant chemotherapy is gemcitabine, as this drug has demonstrated the better efficacy in studies. Other chemotherapeutic agents and gemcitabine in combination with biologic agents are under investigation. Furthermore, predicting response to gemcitabine based chemotherapy and other adjuvant therapies will be invaluable in guiding the practitioner to choose the most appropriate adjuvant treatment. Once adjuvant therapy has been started, accurately quantifying response to therapy is also important. The adjuvant regimen may be appropriately modified if response is inadequate. This review is an update from the 2011 American Society of Clinical Oncology (ASCO) Annual Meeting regarding recent developments in the adjuvant treatment of pancreatic cancer with regards to choice of adjuvant regimen, timing of adjuvant therapy, predicting response to therapy and measuring response to adjuvant therapy. We will present the findings from Abstracts #4039, #4042, #e14519, #4118, and #4024. In conclusion, multiple adjuvant therapeutic regimens are associated with incremental improvements in the management of pancreatic cancer. The timing of initiation of adjuvant therapy appears to be important in outcomes. Research is ongoing into markers that can predict response to adjuvant therapy.
有强有力的证据支持在胰腺癌手术切除后使用辅助化疗,而辅助放化疗的作用仍存在争议。启动辅助治疗的最佳时间尚未明确,但通常在切除术后2 - 10周开始。一线辅助化疗药物是吉西他滨,因为该药在研究中已显示出更好的疗效。其他化疗药物以及吉西他滨与生物制剂联合使用正在研究中。此外,预测对基于吉西他滨的化疗及其他辅助治疗的反应,对于指导医生选择最合适的辅助治疗将非常有价值。一旦开始辅助治疗,准确量化治疗反应也很重要。如果反应不足,辅助治疗方案可适当调整。本综述是对2011年美国临床肿瘤学会(ASCO)年会关于胰腺癌辅助治疗近期进展的更新,内容涉及辅助治疗方案的选择、辅助治疗的时机、预测治疗反应以及评估辅助治疗反应。我们将展示摘要#4039、#4042、#e14519、#4118和#4024的研究结果。总之,多种辅助治疗方案与胰腺癌治疗管理的逐步改善相关。辅助治疗开始的时机似乎对治疗结果很重要。关于能够预测辅助治疗反应的标志物的研究正在进行中。