Adjuvant therapy for pancreatic cancer

Abstract

Pancreatic cancer is uniformly fatal unless it can be surgically resected. Survival rates for the 15% to 20% of patients who have resectable disease, however, are a disappointing 10% to 30%, depending on the status of margins and surrounding lymph nodes. In the mid-1980s, a landmark study by the Gastrointestinal Tumor Study Group was the first to demonstrate a survival benefit from adjuvant therapy in the form of chemoradiation. Since then, several studies in both North America and Europe have tested the role of adjuvant chemotherapy or chemoradiation in pancreatic cancer, and the results have stirred great controversy. For this review, the evidence for adjuvant therapy in pancreatic cancer was examined, and the significant practice differences that exist between North American and European oncologists were highlighted. The authors investigated the results from the European Study Group for Pancreatic Cancer-1 trial and the reasons why that study has served to reinforce rather than resolve these trans-Atlantic differences. They also reviewed preliminary data from more recent adjuvant trials and explored the possible benefits of a neoadjuvant approach.

AMG 479, a fully human anti–insulin-like growth factor receptor type I monoclonal antibody, inhibits the growth and survival of pancreatic carcinoma cells

“…Less than 4% of the 200,000 patients annually diagnosed with pancreatic carcinoma live more than 5 years, due largely to extensive, unresectable, metastatic disease present at the time of diagnosis (1). Gemcitabine, which was approved in 1996 based on a 1-month increase in median survival time, is the standard of care for patients with this disease (2).…”

Interaction of tumour cells with their microenvironment: ion channels and cell adhesion molecules. A focus on pancreatic cancer

“…Although surgery remains the cornerstone of cure, the addition of adjuvant treatments is required [70]. Chemotherapy (in Europe) or radiochemotherapy (in North America) has been used, either as adjuvant to surgery or as definitive treatment for unresectable disease, with conflicting results [71,72]. Failure of traditional therapeutic approaches for this devastating disease had led to many efforts towards the study of molecular biology and targeted therapies, in order to create a multimodal therapeutic strategy [73].…”

Pancreato-Biliary Cancers – Diagnosis and Management

“…Given the high loco-regional recurrence rate and a tendency towards early liver metastasis after pancreatic resection, adjuvant chemotherapy has been employed though its benefits remain controversial with mixed results until recently (Brennan, 2004;Zuckerman and Ryan, 2008). Of the six randomized controlled trials that examined the effects of adjuvant chemotherapy after pancreatic resection (Kalser and Ellenberg, 1985;Moertel et al, 1994;Neoptolemos et al, 2001;Neoptolemos et al, 2004;Oettle et al, 2007;Regine et al, 2008), only two trials were able to demonstrate a survival benefit of adjuvant chemotherapy (Neoptolemos et al, 2001;Neoptolemos et al, 2004).…”