Chemotherapy for Pancreatic Cancer

pancreas

Chemotherapy in the treatment of pancreatic cancer (also known as pancreatic adenocarcinoma) is applicable in at least three settings:

  • Metastatic disease
  • Locally advanced unresectable disease
  • As adjuvant chemotherapy

However, chemotherapy treatment for pancreatic cancer in any setting has demonstrated a limited efficacy, and in fact there is little difference in the agents used or the stage at which they're often given.

Metastatic disease

Standard front-line chemotherapy for metastatic disease is gemcitabine (marketed as Gemzar), although a small variety of combinations with gemcitabine have shown some potential, and they include:

  • Gemcitabine + erlotinib
  • Gemcitabine + cisplatin
  • Gemcitabine + oxaliplatin
  • Gemcitabine + fluoropyrrimidine

Second-line chemotherapy may involve one or more of the following agents:

  • 5-FU/leucovorin
  • Capecitabine
  • Oxaliplatin + 5-FU/leucovorin

Locally advanced unresectable disease

Chemoradiation (or radiochemotherapy) involving 5-FU/leucovorin is a common front-line treatment for locally advanced pancreatic cancers, and this may be preceded by gemcitabine-based chemotherapy.

As adjuvant chemotherapy

Adjuvant chemotherapy in the treatment of pancreatic cancer is not well-understood, and the chemotherapeutic agents aren't any different than they are in any other setting for this disease; still, for some patients gemcitabine or 5-FU/leucovorin are used post-surgery.

References

  • Boyiadzis, Michael M. et al. Hematology-Oncology Therapy. 2007. New York: McGraw Hill, Medical Publishing Division.
  • Ko, Andrew H MD et al. 2008. Everyone's Guide to Cancer Therapy, Fifth Ed. Kansas City. Andres McMeel Publishing LLC.
  • National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology- V.2.2010. Pancreatic adenocarcinoma

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