Department of Medical Oncology, Regional Cancer and Blood Service, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand.
Ther Adv Med Oncol. 2010 Mar;2(2):85-106. doi: 10.1177/1758834009357188.
Systemic treatment of metastatic pancreatic adenocarcinoma achieves only modest benefits, with evidence indicating a survival advantage with 5-fluorouracil (5-FU) over best supportive care alone, and further advantage of single-agent gemcitabine over 5-FU. There are very few regimens better than single-agent gemcitabine despite multiple trials of cytotoxic and targeted agents. The addition of a platinum agent has improved response rate but not survival. The addition of erlotinib has improved survival but only by a small margin. The use of gemcitabine in multidrug regimens containing one or more of: a platinum agent; fluoropyrimidine; anthracycline; and taxane has demonstrated advantages in response rate, progression-free survival and, in one randomized study, overall survival. After gemcitabine failure, second-line therapy with oxaliplatin and 5-FU provides a further survival advantage. Further advances depend upon the current and future clinical trials investigating enhanced delivery of current agents, new agents and novel modalities, improved supportive care, and treatment more tailored to the individual patient and tumour.
转移性胰腺腺癌的系统治疗仅能带来适度的益处，有证据表明，5-氟尿嘧啶（5-FU）联合最佳支持治疗优于单纯最佳支持治疗，而吉西他滨单药治疗优于 5-FU。尽管进行了多次细胞毒性药物和靶向药物的试验，但很少有方案优于吉西他滨单药治疗。铂类药物的加入提高了缓解率，但不能提高生存率。厄洛替尼的加入提高了生存率，但只有很小的幅度。吉西他滨联合多种药物治疗方案（包含一种或多种铂类药物、氟嘧啶类药物、蒽环类药物和紫杉烷类药物），在缓解率、无进展生存期方面具有优势，在一项随机研究中，在总生存期方面也具有优势。吉西他滨治疗失败后，二线治疗采用奥沙利铂和 5-FU 可进一步提高生存率。进一步的进展取决于目前和未来的临床试验，这些试验旨在研究提高现有药物、新药物和新方法的递送效率，改善支持性治疗，并更针对个体患者和肿瘤进行治疗。
