University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94115, USA.
Gastroenterology. 2013 Jun;144(6):1316-26. doi: 10.1053/j.gastro.2013.01.078.
Despite our improved understanding of pancreatic cancer biology and ability to perform more complex pancreatic cancer surgeries that produce better short-term outcomes, major progress toward increasing survival times has been painstakingly slow. Through the often-repeated, dismal survival statistics, it is easy to lose sight of real progress that has been made in pancreatic cancer therapy. It is particularly interesting to observe the extent to which these advances are interdependent and the effects they have had on practice. For example, during the past 5-10 years, we have seen widespread adoption of pancreatic imaging protocols that allow for objectively defined criteria of resectability. This has led to the definition of "borderline resectable pancreatic cancer"--a new clinical category that has affected the design of clinical trials. A major change in our surgical approach has been the move to minimally invasive pancreatectomy, which continues to gain broader acceptance and use, particularly for left-sided lesions. Although many new agents have been developed aimed at putative molecular targets, recent breakthroughs in therapy for advanced disease have arisen from our ability to safely give patients combination cytotoxic chemotherapy. We are now faced with the challenge of combining multidrug, cytotoxic chemotherapies with newer-generation agents. Ultimately, the hope is that drug combinations will be selected based on biomarkers, and strategies for pancreatic cancer therapy will be personalized, which could prolong patients' lives and reduce toxicity. We review the major advances in pancreatic cancer therapy during the last 5 years, and discuss how these have set the stage for greater progress in the near future.
尽管我们对胰腺癌生物学有了更好的理解，并且能够进行更复杂的胰腺癌手术，从而产生更好的短期结果，但在提高生存时间方面取得重大进展的过程却异常缓慢。通过反复出现的、令人沮丧的生存统计数据，人们很容易忽略在胰腺癌治疗方面已经取得的真正进展。特别有趣的是，观察这些进展在多大程度上相互依存以及它们对实践的影响。例如，在过去的 5-10 年中，我们已经看到广泛采用了允许客观定义可切除性标准的胰腺成像方案。这导致了“边缘可切除胰腺癌”的定义——这是一个新的临床类别，影响了临床试验的设计。我们的手术方法发生了重大变化，即转向微创胰切除术，这种手术方法继续得到更广泛的接受和使用，特别是对于左侧病变。尽管已经开发了许多针对假定分子靶点的新药物，但晚期疾病治疗的最新突破来自于我们能够安全地为患者提供联合细胞毒性化疗的能力。我们现在面临的挑战是将多药、细胞毒性化疗与新一代药物联合使用。最终，希望能够根据生物标志物选择药物组合，并使胰腺癌治疗策略个性化，这可能会延长患者的生命并降低毒性。我们回顾了过去 5 年来胰腺癌治疗的主要进展，并讨论了这些进展如何为近期取得更大进展奠定了基础。
