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Chemotherapy for Advanced Pancreatic Cancer

Pancreatic Cancer

Abstract

Gemcitabine has been key to the management of advanced pancreatic cancer since its superiority over 5-fluorouracil (5-FU) for clinical benefit, and overall survival (OS) was established in a clinical trial published in 1997. The addition of the tyrosine kinase inhibitor (TKI), erlotinib, to gemcitabine has shown a modest but statistically significant improvement in OS compared to gemcitabine alone, making it a new standard for advanced pancreatic cancer. However, limited access to targeted agents due to high costs has meant that erlotinib is not available to all patients. A meta-analysis has demonstrated that the combination of the oral fluoropyrimidine, capecitabine, and gemcitabine (GemCap) has an OS benefit of a similar magnitude to combination with erlotinib; therefore, it is a very good alternative for patients without access to funding for the higher-cost drug and is an accepted standard at many centers. Pooled analyses of trials combining gemcitabine with platinum agents have similarly demonstrated an advantage over single-agent gemcitabine offering a further therapeutic option. Recently, the therapeutic armamentarium for advanced pancreatic cancer has been enriched by two additional chemotherapy regimens including a combination of 5-FU, folinic acid, irinotecan, and oxaliplatin (FOLFIRINOX) and a combination of gemcitabine plus nab-paclitaxel. Both regimens have been demonstrated to be superior to gemcitabine alone in terms of response rate, progression-free survival, and OS and have become standard first-line treatments for patients with good performance status. Also, evidence has increasingly emerged suggesting that chemorefractory patients may benefit from the use of second-line chemotherapy. Clinical trials have shown that combining 5-FU and folinic acid with either oxaliplatin or nanoliposomal irinotecan can improve OS following progression to first-line gemcitabine-based therapies. Nevertheless, despite recent advances in medical oncology, survival from advanced pancreatic cancer remains poor and significant breakthroughs are urgently needed.

Conflicts of Interest

Dr. Sclafani, Dr. Okines and Dr. Ratnayake have no potential conflict of interest to declare. Dr. Chau received honoraria from Roche, Merck Serono, Sanofi-Aventis, Pfizer, Eli-Lilly and Taiho and had advisory roles with Roche, Merck Serono, Sanofi-Aventis, Bristol Myers Squibb, Eli-Lilly, Novartis and Gilead Science. He also received research funding from Merck-Serono, Novartis, Roche and Sanofi Aventis. Professor Cunningham has previously received honoraria for presentations and advisory boards from Roche, Merck Serono, Amgen and Sanofi-Aventis and has received research funding from Roche, Merck Serono, Amgen, Sanofi-Aventis, Celgene, Novartis, AstraZeneca, MedImmune, Bayer, and Merrimack.

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Cunningham, D., Sclafani, F., Okines, A., Ratnayake, G., Chau, I. (2016). Chemotherapy for Advanced Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6631-8_37-2

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  1. Latest

    Chemotherapy for Advanced Pancreatic Cancer
    Published:
    04 July 2017

    DOI: https://doi.org/10.1007/978-1-4939-6631-8_37-3

  2. Original

    Chemotherapy for Advanced Pancreatic Cancer
    Published:
    20 February 2017

    DOI: https://doi.org/10.1007/978-1-4939-6631-8_37-2