Chemotherapy for Pancreatic Cancer
Chemotherapy for Pancreatic Cancer
In pancreatic cancer, major advances have been made in relation to the establishment of standard treatments in recent years. However, the survival of patients with pancreatic cancer still remains dismal. Although administration of many molecular-targeted agents in combination with gemcitabine have been investigated, none of the agents, except erlotinib, showed efficacy. In order to develop more molecular-targeted agents, it is important to find unique biomarkers or driver mutations for carcinogenesis or progression of pancreatic cancer.
Various intensive regimens such as FOLFIRINOX and gemcitabine plus nab-paclitaxel have been developed. New molecular-targeted agents are also expected to be introduced for pancreatic cancer. It would be important to identify patients that would benefit from these regimens based on clinical information about the patient and biomarkers from the point of view of establishment of an individualized treatment strategies.
In recent years, many clinical trials have investigated new chemotherapy regimens for patients with metastatic pancreatic cancer as distinct from patients with locally advanced disease, because of the differences in the characteristics and prognosis of patients with metastatic and locally advanced disease. A new chemotherapeutic regimen can be accurately evaluated only in patients with metastatic disease. On the other hand, in patients with locally advanced disease, intensive chemotherapy or chemoradiotherapy may be useful for down-staging the tumor and make the patient suitable for surgical resection.
Although currently, surgery remains the only potentially curative treatment for pancreatic cancer, most patients develop recurrence. Survival benefit of adjuvant chemotherapy was demonstrated, however, the prognosis of patients with advanced disease stages such as stage II and III is still poor. The efficacy of neoadjuvant therapy has been examined for these patients. Various neoadjuvant therapies have recently been investigated, and RCTs are needed to confirm the efficacy and safety of neoadjuvant therapy.
Since a large number of patients is required to confirm the survival benefit in RCTs, it is difficult to conduct these trials in a single country. Many clinical trials using new agents are conducted as global studies or Asian studies including Japan. Global cooperation in multinational trials is essential to achieve the goal.
Future Direction
In pancreatic cancer, major advances have been made in relation to the establishment of standard treatments in recent years. However, the survival of patients with pancreatic cancer still remains dismal. Although administration of many molecular-targeted agents in combination with gemcitabine have been investigated, none of the agents, except erlotinib, showed efficacy. In order to develop more molecular-targeted agents, it is important to find unique biomarkers or driver mutations for carcinogenesis or progression of pancreatic cancer.
Various intensive regimens such as FOLFIRINOX and gemcitabine plus nab-paclitaxel have been developed. New molecular-targeted agents are also expected to be introduced for pancreatic cancer. It would be important to identify patients that would benefit from these regimens based on clinical information about the patient and biomarkers from the point of view of establishment of an individualized treatment strategies.
In recent years, many clinical trials have investigated new chemotherapy regimens for patients with metastatic pancreatic cancer as distinct from patients with locally advanced disease, because of the differences in the characteristics and prognosis of patients with metastatic and locally advanced disease. A new chemotherapeutic regimen can be accurately evaluated only in patients with metastatic disease. On the other hand, in patients with locally advanced disease, intensive chemotherapy or chemoradiotherapy may be useful for down-staging the tumor and make the patient suitable for surgical resection.
Although currently, surgery remains the only potentially curative treatment for pancreatic cancer, most patients develop recurrence. Survival benefit of adjuvant chemotherapy was demonstrated, however, the prognosis of patients with advanced disease stages such as stage II and III is still poor. The efficacy of neoadjuvant therapy has been examined for these patients. Various neoadjuvant therapies have recently been investigated, and RCTs are needed to confirm the efficacy and safety of neoadjuvant therapy.
Since a large number of patients is required to confirm the survival benefit in RCTs, it is difficult to conduct these trials in a single country. Many clinical trials using new agents are conducted as global studies or Asian studies including Japan. Global cooperation in multinational trials is essential to achieve the goal.
