Adjuvant therapy for pancreatic cancer

Douglass, Harold O.

doi:10.1007/bf00308637

Cited by 34 publications

(15 citation statements)

References 30 publications

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“…Only in colorectal cancer could a chemotherapeutic approach with 5-fluorouracil and levamisole be proven to increase the survival rate in Dukes C tumor stages [4]. So far, in gastric and pancreatic cancer no significant effects of any adjuvant chemotherapy have been observed [6,7]. Drug resistance and the lack of a functioning p53 tumor suppressor gene, which mediates a chemo-and radiotherapeutic effect by inducing apoptosis, are several reasons for the failure of chemotherapy [29].…”

Section: Discussionmentioning

confidence: 98%

“…In Dukes C colorectal cancer, it was shown that a combination of 5-fluorouracil and levamisol [4] (in rectal cancer combined with local radiation [5]) positively affects the survival rate. Presently, in pancreatic [6] and in gastric cancer [7], no effective adjuvant therapy is available. In this situation new therapeutic concepts are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

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Frequent expression of complement resistance factors CD46, CD55, and CD59 on gastrointestinal cancer cells limits the therapeutic potential of monoclonal antibody 17-1A

et al. 1997

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Frequent expression of complement resistance factors CD46, CD55, and CD59 on gastrointestinal cancer cells limits the therapeutic potential of monoclonal antibody 17-1A

et al. 1997

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“…At present, the overall 5-year survival remains < 5% [1]. Although complete surgical resection offers patients the only hope for long-term survival with actuarial 5-year survival rates of 18% to 24%, the majority of patients present with locally advanced, unresectable, or metastatic disease [2][3][4][5][6][7][8]. Studies by the Gastrointestinal Tumor Study Group (GITSG) evaluated external beam radiotherapy with 5-fluorouracil (5-FU) in patients with nonmetastatic pancreatic cancer [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Gemcitabine following radiotherapy with concurrent 5‐fluorouracil for nonmetastatic adenocarcinoma of the pancreas

Kachnic

Shaw

Manning

et al. 2001

Intl Journal of Cancer

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SUMMARY Gemcitabine has been shown to be an active agent in the treatment of pancreatic cancer. This study was conducted to prospectively examine the tolerance and early efficacy of adjuvant gemcitabine following radiotherapy with concurrent 5-fluorouracil (5-FU) for nonmetastatic pancreatic adenocarcinoma. Twenty-three patients, median age 64 years, were treated with combined modality therapy. Nine patients underwent tumor resection before chemoradiation; 14 patients with locally unresectable tumors received definitive chemoradiation. Radiotherapy utilized four fields to the tumor and lymphatics to 45 Gy, plus a lateral boost to 50.4 Gy. Concurrent 5-FU 500 mg/m 2 /day was administered on days 1-3 and 29-31, followed by 4 months of gemcitabine 1,000 mg/m 2 / week for 3 weeks (fourth week break). Adjuvant gemcitabine was well tolerated. Eightythree percent of the patients completed three to four cycles. The primary dose-limiting toxicity was leukopenia, which was observed in 10 patients (43%). Nonhematologic toxicities were reported in five patients (22%). There were no cases of gemcitabine-induced radiation recall and there have been no deaths attributed to treatment toxicity. Median follow-up for the 23 patients was 12 months (range, 5-50); the actuarial median survival was 13 months. This report confirms that adjuvant gemcitabine following radiotherapy with concurrent 5-FU for nonmetastatic pancreatic adenocarcinoma can be safely administered.

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“…Positive results from randomised trials on postoperative adjuvant chemotherapy (CT) [2] or radiochemotherapy (RT) [16] have given support to use those treatments after resection. Postoperative RT improves survival of resected pancreatic cancer patients [19,80].…”

Section: Introductionmentioning

confidence: 99%

Resection and radiochemotherapy of pancreatic cancer – the future?

Link

Formentini²,

Leder³

et al. 1998

Langenbecks Arch Chir

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Background: To improve the surgical outcome after resection of pancreatic adenocarcinomas, multimodal treatment concepts need to be applied and improved. The controversies among those being pro and contra adjuvant treatment need an up-to-date review of the indications and results achievable with various treatment modalities. Patients/Methods: The literature regarding the indications and results of adjuvant/neoadjuvant therapies in pancreatic cancer was reviewed to provide a solid base for current recommendations and future developments. The biology of the disease in the spontaneous course, after surgery and during/after various palliative and adjuvant/neoadjuvant treatment modalities was focussed on, to characterise the disease for an optimally targeted treatment in conjunction with surgical removal of the tumour. The results of systemic and regional chemotherapy and radiotherapy, either alone or in combination, before, during and after surgery were critically analysed with respect to the oncological possibilities and pitfalls of each treatment method. Results: In two randomised trials, one testing postoperative radiochemotherapy (GITSG), and one postoperative chemotherapy, the adjuvant treatment achieved a significant prolongation of the median survival time. The 5-year and 10-year survival rates were improved in the GITSG study. The EORTC-GITCCG trial could not confirm the benefit of adjuvant radiochemotherapy. This study had a different design than the GITSG trial. Several historical control studies supported the beneficial effect of postoperative radiochemotherapy. In three historical control trials using regional chemotherapy, one with intraoperative radiotherapy , the survival times were improved compared with surgery alone. Intraoperative or postoperative radiotherapy as single modalities might reduce local relapses, but a survival advantage is still debated. Preoperative neoadjuvant radiochemotherapy has several advantages (downstaging, devitalising margins and lymph node metastases, compatibility of treatment vs. postoperative radiochemotherapy), and does not seem to increase the postoperative morbidity. Several trials have confirmed the feasibility of this concept, but no survival advantage has yet been proven. Systemic and regional chemotherapy is able to downstage primarily nonresectable pancreatic cancers. Conclusions: Postoperative adjuvant radiochemotherapy with up-to-date protocols can be recommended for routine treatment, if the surgeon or the patient desires to improve the usually remote prognosis after surgery alone. For those being indecisive or against adjuvant therapy, the participation in trials, e.g. the ESPAC 1 and 2 studies, is strongly recommended. Regarding our own positive experience with adjuvant regional chemotherapy and in view of the postresectional progression pattern, we currently favour adjuvant radiochemotherapy, with the chemotherapy delivered regionally via the celiac axis. This concept will be tested against surgery alone in the ESPAC 2 trial. Neoadjuvant therapies have a g...

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Adjuvant therapy for pancreatic cancer

Cited by 34 publications

References 30 publications

Frequent expression of complement resistance factors CD46, CD55, and CD59 on gastrointestinal cancer cells limits the therapeutic potential of monoclonal antibody 17-1A

Frequent expression of complement resistance factors CD46, CD55, and CD59 on gastrointestinal cancer cells limits the therapeutic potential of monoclonal antibody 17-1A

Gemcitabine following radiotherapy with concurrent 5‐fluorouracil for nonmetastatic adenocarcinoma of the pancreas

Resection and radiochemotherapy of pancreatic cancer – the future?

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