Median overall survival was 6. In addition, Burtness et al conducted a randomized phase II trial of irinotecan and docetaxel with or without cetuximab in patients with good performance status and no prior chemotherapy for metastatic disease ECOG Median overall survival was equivalent, at 5.
Although these results were discouraging, inhibition of angiogenesis may still play a role in advanced pancreatic cancer. In 53 patients, this regimen resulted in a median overall survival of 8. For many decades the medical community has been striving to improve outcomes for patients afflicted with pancreatic cancer. This has been challenging, given the location of this tumor near vital vascular structures, the biologically aggressive nature of these cancers with early metastasis, and their resistance to traditional chemotherapy and radiation.
Over the years, progress has been made in diagnostic imaging, endoscopic techniques, surgical interventions, and the delivery of radiation therapy and chemotherapy. In addition, beyond traditional chemotherapy, we are now seeing preliminary signs that targeted therapies may be useful in this disorder. Brand names are listed in parentheses only if a drug is not available generically and is marketed as no more than two trademarked or registered products.
More familiar alternative generic designations may also be included parenthetically. Despite this progress, adenocarcinoma of the pancreas remains one of the most lethal malignancies.
It is important that physicians continue to focus on improving care for these patients. It is also time to change the design of clinical trials for inoperable pancreas cancer. Although many phase II studies with combinations of various chemotherapeutic and targeted agents with gemcitabine have shown promise, only the preliminary analysis for one phase III trial with capecitabine and the phase III study with erlotinib have been positive.
Studies investigating new therapeutic agents or combinations need to be designed separately for patients with good performance status and locally advanced disease. This has been a successful paradigm in other malignancies. In advanced hepatocellular carcinoma, a recent study showed improved overall survival with sorafenib Nexavar. However, enrollment in this study was limited to patients with good performance status and Child-Pugh status.
Future trials need to incorporate our ever-increasing understanding about the molecular characteristics of this cancer, both to develop new targeted agents and to identify biomarkers to predict treatment effect. These changes in our research endeavors and new paradigms for trial design offer the best hope to reduce the high mortality related to this disease. Financial Disclosure: Dr. J Am Coll Surg , The Gastrointestinal Tumor Study Group: A multi-institutional comparative trial of radiation therapy alone and in combination with 5-fluorouracil for locally unresectable pancreatic carcinoma.
Ann Surg , J Clin Oncol 25 18S s, New York, McGraw-Hill, Support Care Cancer , Radiology , Comparison with conventional sonography, computed tomography, and angiography. Gastroenterology , J Gastrointest Surg incl discussion , Available at www. Accessed September 24, Ann Surg Oncol , Noble M, Gress FG: Techniques and results of neurolysis for chronic pancreatitis and pancreatic cancer pain.
Curr Gastroenterol Rep , Maire F, Hammel P, Ponsot P, et al: Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol , Lancet , Cancer , Semin Oncol , J Clin Oncol , Int J Gastrointest Cancer , Talamonti MS, Catalano PJ, Vaughn DJ, et al: Eastern Cooperative Oncology Group Phase I trial of protracted venous infusion fluorouracil plus weekly gemcitabine with concurrent radiation therapy in patients with locally advanced pancreas cancer: a regimen with unexpected early toxicity.
Talamonti MS, Small W Jr, Mulcahy MF, et al: A multi-institutional phase II trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Small W, Talamonti M, Normolle D, et al: A phase II trial of full-dose gemcitabine with concurrent radiation therapy in patients with resectable or unresectable non-metastatic pancreatic cancer.
Small WJ, Mulcahy M, Benson A, et al: A phase II trial of weekly gemcitabine and bevacizumab in combination with abdominal radiation therapy in patients with localized pancreatic cancer abstract Epelbaum R, Rosenblatt E, Nasrallah S, et al: Phase II study of gemcitabine combined with radiation therapy in patients with localized, unresectable pancreatic cancer.
J Surg Oncol , J Natl Cancer Inst , John Allendorf Dr. Vascular resection and reconstruction The major vascular structures in the local area include the superior mesenteric and portal veins and the hepatic and superior mesenteric arteries. Michael D. Ammazzalorso Memorial Pancreatic Cancer Symposium.
Contact Us Get Directions Glossary. Sitemap Privacy Non Discrimination Statement. Clinical trials are available to test novel treatments for inoperable pancreatic cancer. Being involved in a clinical trial could give you access to new therapies that you might not otherwise be given.
You can also visit ClinicalTrials. When discussing your outlook , your doctor might give you information on 5-year survival rates. This refers to the percentage of people who live at least 5 years after being diagnosed. Pancreatic cancer, in general, has the highest mortality rate of all major cancers. Ten percent of people diagnosed between and will survive more than 5 years. As newer ways to detect and treat pancreatic cancer are being discovered, these statistics may change in the future.
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