Advances in Pancreatic Cancer Treatment

Advances in Pancreatic Cancer Treatment

M Wasif Saif, Soonmo Peter Kang
US Oncological Disease 2007 - Issue I
Published: October 2008
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Each year, approximately 32,000 new patients are diagnosed with pancreatic cancer (PC) in the US. The incidence has been increasing since the 1930s. Prognosis of PC is extremely poor. Approximately 31,000 patients in the US die from PC each year, making it the fourth leading cause of cancer-related death in the US.1 Five-year overall survival (OS) rate for advanced pancreatic cancer (APC) is less than 1%.2 Poor prognosis had been attributed to the inability to diagnose while the tumor is resectable and its propensity toward early vascular dissemination and spread to regional lymph nodes. In inoperable PC, gemcitabine is the only cytotoxic agent approved by the US Food and Drug Administration (FDA), based on the results of the multicentered randomized phase III clinical trial that compared 5-fluorouracil (5-FU) with gemcitabine. In this study, treatment with gemcitabine resulted in a relative improvement of 36% in median survival (MS) (5.7 versus 4.2 months for gemcitabine and 5-FU, respectively).

For the past 10 years, many cytotoxic and targeted agents have been pitted against or combined with gemcitabine in randomized phase III trials and no drug has been shown to be superior to single-agent gemcitabine. Luckily, in the past year, for the first time, two large, randomized phase III studies in APC—capecitabine plus gemcitabine versus gemcitabine, and erlotinib plus gemcitabine versus gemcitabine—have demonstrated the superiority of a gemcitabine-containing combination over single-agent gemcitabine. In this paper we will review the current advancement in PC treatment.

Resectable Pancreatic Cancer
Ten percent of patients have resectable disease at the time of PC diagnosis. Prognosis of patients after complete resection of node-negative cancer is poor, with three-year disease-specific survival rate at 27% (95% confidence interval (CI): 23–32%) and MS of 15–19 months.3 The treatment plan in the adjuvant setting is currently dependent on which side of the Atlantic you are located: chemotherapy alone is mostly used in Europe—European Study Group for Pancreatic Cancer-1 (ESPAC-1), Charité Onkologie Clinical-001 (CONKO-001)—while chemoradiation therapy (CRT) is the current standard in the US—Gastrointestinal Study Group (GITSG), Radiation Therapy Oncology Group 9704 (RTOG 9704).

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