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Chemotherapy for Advanced Pancreatic Cancer

  • Francesco Sclafani
  • David Cunningham
  • Alicia Okines
  • Gihan Ratnayake
  • Ian Chau
Reference work entry

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.

Keywords

Advanced pancreatic cancer Metastatic pancreatic cancer Chemotherapy Targeted therapy Chemoradiotherapy 

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Francesco Sclafani
    • 1
  • David Cunningham
    • 1
  • Alicia Okines
    • 1
  • Gihan Ratnayake
    • 1
  • Ian Chau
    • 1
  1. 1.Department of MedicineThe Royal Marsden NHS Foundation TrustLondon and SurreyUK

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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