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Chemotherapy for Advanced Pancreatic Cancer

  • Alicia Okines
  • Gihan Ratnayake
  • Ian Chau
  • David Cunningham

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 new meta-analysis has demonstrated that the combination of the oral fluoropyrimidine, capecitabine, with 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, particularly in metastatic patients with good performance status. Patients with locally advanced inoperable pancreatic cancer may benefit from consolidation chemoradiation after induction chemotherapy, but this is currently under evaluation in clinical trials. Despite recent advances in medical oncology, survival from advanced pancreatic cancer remains poor.

Keywords

Overall Survival Epidermal Growth Factor Receptor Pancreatic Cancer Median Overall Survival Median Progression Free Survival 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Alicia Okines
    • 1
  • Gihan Ratnayake
    • 1
  • Ian Chau
    • 1
  • David Cunningham
    • 1
  1. 1.The Royal Marsden HospitalLondon and SurreyUK

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