Adjuvant therapy for pancreatic cancer

Neoptolemos, John P.; Kerr, David

doi:10.1002/bjs.1800820804

Cited by 19 publications

(3 citation statements)

References 20 publications

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“…The results of this trial were consistent with those from the original GITSG study but also with the UK data in patients receiving no adjuvant treatment [34].…”

Section: Adjuvant Therapysupporting

confidence: 86%

Neoadjuvant, adjuvant, and palliative treatment of pancreatic cancer

Birk

Beger

2001

Curr Gastroenterol Rep

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Pancreatic cancer remains a highly malignant disease. Curative treatment is only possible for patients diagnosed at a very early stage. Therefore, the vast majority of pancreatic cancer patients receive palliative treatment. Surgical palliation is offered to patients who are found not to have a resectable tumor. The treatment of obstructive jaundice is managed by stenting of the common bile duct or by a surgical bypass. The best possible surgical procedure should be based on the factors that influence hospital mortality, length of survival, and quality of life. In patients with a life expectancy of longer than 3 months, surgical bypass is recommended, with hepaticojejunostomy the treatment of choice. In the same surgical procedure, the relief of duodenal obstruction with a gastroenteric bypass should be achieved. Chemotherapy, radiotherapy, or a combination of both is employed as a neoadjuvant measure, as an adjuvant treatment, or, in most patients, as palliation. As palliative chemotherapy alone, 5-fluorouracil (5-FU) plus folinic acid is still the treatment of choice; however, newer drugs, such as gemcitabine, seem to have similar or marginally better results. Palliative radiochemotherapy with external-beam radiation plus 5-FU and folinic acid seems to lead to better local control of tumor progression but not to better survival, for which distant metastases are the limiting factor.

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“…The results of this trial were consistent with those from the original GITSG study but also with the UK data in patients receiving no adjuvant treatment [34].…”

Section: Adjuvant Therapysupporting

confidence: 86%

Neoadjuvant, adjuvant, and palliative treatment of pancreatic cancer

Birk

Beger

2001

Curr Gastroenterol Rep

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“…A modest prolongation in survival can be achieved in some cases, but side effects are substantial and objective response rates are seen in less than 25% (20,21). It is therefore clear that a new approach to the management of these patients is required.…”

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confidence: 98%

Tolerance and incorporation of a high‐dose eicosapentaenoic acid diester emulsion by patients with pancreatic cancer cachexia

Barber

Fearon

2001

Lipids

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Chemotherapy and radiotherapy offer little benefit to patients with advanced pancreatic cancer. Eicosapentaenoic acid (EPA) has anticancer effects both in vitro and in animal models. The dose of EPA that can be administered to cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules. A high-purity preparation of EPA as a 20% oil-in-water diester emulsion allowed a small study of the tolerance, incorporation, and effects of EPA in high doses in five patients with advanced pancreatic cancer. Patients underwent assessment at baseline and every 4 wk thereafter. All patients managed to tolerate a dose providing 18 g EPA per day, with doses between 9 and 27 g daily being taken for at least a month. Dosage was limited by a sensation of fullness, cramping abdominal pain, steatorrhea, and nausea. All such symptoms were controlled by dose reduction or pancreatic enzyme supplements. No other adverse effects attributable to the trial agent were observed. Plasma phospholipid EPA content increased from around 1% at baseline to 10% at 4 wk and 20% at 8 wk. Incorporation of EPA into red blood cell phospholipids reached levels of around 10%. The present study has shown that a novel, high-purity, EPA diester emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled. The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA.

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“…A significant survival benefit was noted in favor of the treat ment arm [2]. In a British nonrandomized study the GITSG regimen was applied in 40 patients, but the 2-year survival rate appeared to be similar to the UK data fol lowing resection alone [3].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant or Neoadjuvant Therapy for Pancreatic Carcinoma?

Jeekel¹

1997

Digestion

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Whipple’s resection for pancreatic cancer is an inadequate procedure and should be regarded as a lumpectomy. Adjuvant treatment should be directed towards local regional and liver recurrences. In the USA, adjuvant treatment after curative Whipple resection is standard procedure, based upon results of the GITSG study in which postoperative radiotherapy and 5-FU treatment resulted in significantly better survival in 23 patients. Preliminary results of our study in Rotterdam, however, do not seem to confirm these data. In this study, 218 patients were randomly assigned to surgery only or for 40-Gy radiotherapy and 4 weeks 5-FU treatment. Another option is neoadjuvant treatment which has theoretic advantages. A number of nonrandomized studies seem to indicate that radiotherapy and 5-FU treatment may have benefit in pancreatic cancer in a neoadjuvant treatment form. It is not clear which direction to take. Randomized studies are necessary to study the effect of neoadjuvant treatment with radiotherapy and 5-FU or with regional perfusion of the pancreatic area.

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Adjuvant therapy for pancreatic cancer

Cited by 19 publications

References 20 publications

Neoadjuvant, adjuvant, and palliative treatment of pancreatic cancer

Neoadjuvant, adjuvant, and palliative treatment of pancreatic cancer

Tolerance and incorporation of a high‐dose eicosapentaenoic acid diester emulsion by patients with pancreatic cancer cachexia

Adjuvant or Neoadjuvant Therapy for Pancreatic Carcinoma?

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