New directions in the management of advanced pancreatic cancer: a review

  title={New directions in the management of advanced pancreatic cancer: a review},
  author={Caio Max S Rocha-Lima},
  journal={Anti-Cancer Drugs},
  • C. Rocha-Lima
  • Published 1 June 2008
  • Biology, Medicine
  • Anti-Cancer Drugs
Complete surgical resection is the only potentially curative option for pancreatic cancer. However, most patients have advanced/metastatic disease at the time of diagnosis, or will relapse after surgery. Systemic chemotherapy is only palliative. Gemcitabine-based therapy is an acceptable standard for unresectable locally advanced/metastatic pancreatic cancer, but average median survival is only 6 months. The addition of other chemotherapies (including other antimetabolites, platinum, and… 

Pancreatic Cancer Treatment

Current and future clinical trials using natural compounds such as vitamin E compound delta-tocotrienol and curcumin in combination with standard chemotherapy are ongoing to discover more effective ways of treating advanced pancreatic cancer.

Emerging drugs in the treatment of pancreatic cancer

The aims of this review are to define the existing treatments available at present for patients with pancreatic cancers in the neo-adjuvant, adjuvant, locally advanced and metastatic settings, and to highlight the molecular heterogeneity of the cancers and the rationale for targeting specific oncogenic pathways.

Management of advanced pancreatic cancer

Despite the benefit of gemcitabine, most patients with advanced disease still do poorly, with a median time-to-tumor progression between 2 and 3 months and median overall survival of 4–6 months.

The role of radiotherapy in locally advanced pancreatic carcinoma

The benefits associated with local therapies, including radiotherapy and surgical resection, as they relate to improved local disease control, prolonged overall survival and improved symptom control are focused on.

Challenges in developing targeted therapy for pancreatic adenocarcinoma

The molecular heterogeneity typical of pancreatic cancers is described and targeted therapies in development are discussed, suggesting that targeting multiple oncogenic pathways using novel targeted therapies could improve patient survival.

Histone deacetylase inhibitors and pancreatic cancer: are there any promising clinical trials?

Clinical data for HDACIs in patients with pancreatic cancer are inadequate, because only a few studies have included patients suffering from this type of neoplasm and the number of Pancreatic cancer patients that entered HDACI phase II/III trials, among others with advanced solid tumors, is very limited.

Preclinical studies identify novel targeted pharmacological strategies for treatment of human malignant pleural mesothelioma

The recently described isolation of TICs from hMPM, the proposed main pharmacological target for novel antitumoural drugs, may contribute to better dissect the biology and multidrug resistance pathways controlling hM PM growth.

Current evidence for histone deacetylase inhibitors in pancreatic cancer.

HDACIs constitute a promising treatment for pancreatic cancer with encouraging anti-tumor effects, at well-tolerated doses, as well as their antiproliferative effects in animal models are presented.



Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.

The results support the use of gemcitabine as adjuvant chemotherapy in resectable carcinoma of the pancreas by significantly delayed the development of recurrent disease after complete resection of pancreatic cancer compared with observation alone.

Marimastat as first-line therapy for patients with unresectable pancreatic cancer: a randomized trial.

Evidence of a dose response for marimastat in patients with advanced pancreatic cancer is provided, and both agents were well tolerated, although grade 3 or 4 toxicities were reported in 22% and 12% of the gemcitabine- and marimaston-treated patients, respectively.

Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group.

  • M. MooreD. Goldstein W. Parulekar
  • Medicine, Biology
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2007
To the authors' knowledge, this randomized phase III trial is the first to demonstrate statistically significantly improved survival in advanced pancreatic cancer by adding any agent to gemcitabine.

Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial.

It is demonstrated that gemcitabine is more effective than 5-FU in alleviation of some disease-related symptoms in patients with advanced, symptomatic pancreas cancer and confers a modest survival advantage over treatment with5-FU.

Phase II trial of capecitabine and oxaliplatin in patients with advanced or metastatic pancreatic adenocarcinoma.

The combination of CAP and OX is reasonable and tolerable treatment of pancreas cancer with activity even in pts receiving second line chemotherapy.

Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor, in combination with gemcitabine for advanced pancreatic cancer: a multicenter phase II Trial.

Cetuximab in combination with gemcitabine showed promising activity against advanced pancreatic cancer.

Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer.

  • H. KindlerG. Friberg E. Vokes
  • Medicine, Biology
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2005
The combination of bevacizumab plus gemcitabine is active in advanced pancreatic cancer patients, and the response rate and overall survival of patients who received gem citabine with the recombinant humanized anti-VEGF monoclonal antibody was assessed.

Front-line treatment of inoperable or metastatic pancreatic cancer with gemcitabine and capecitabine: an intergroup, multicenter, phase II study.

In patients with pancreatic cancer, the combination of GEM with CAP is an active and well tolerated regimen that merits further evaluation in prospective randomized studies.

Phase III study of erlotinib in combination with cisplatin and gemcitabine in advanced non-small-cell lung cancer: the Tarceva Lung Cancer Investigation Trial.

Erlotinib with concurrent cisplatin and gemcitabine showed no survival benefit compared with chemotherapy alone in patients with chemotherapy-naïve advanced NSCLC.

Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection.

The efficacy of combined radiation and fluorouracil as adjuvant therapy for pancreatic cancer is suggested by a prospective randomized study conducted by the Gastrointestinal Tumor Study Group, which was terminated prematurely because of an unacceptably low rate of accrual.