Locally Advanced Pancreatic Adenocarcinoma: Where Are We and Where Are We Going?
Abstract
Although many cancers have seen a decline in rates due to screening techniques, the lack of viable screening for pancreatic cancer yields a large number of patients presenting with locally advanced and metastatic disease. Interesting new data regarding the management of locally advanced pancreatic cancer was presented at the 2010 ASCO Gastrointestinal Cancers Symposium, January 22-24, Orlando, FL, USA. Crane et al. presented phase II data exploring induction chemotherapy followed by chemoradiotherapy with multiple agents including cetuximab, gemcitabine, oxaliplatin and capecitabine (Abstract #132). Phase II data was also presented examining the role of S-1, an oral fluoropyrimidine, in the locally advanced setting (Abstract #196). In the wake of several studies exploring the role of platinum compounds in combination with gemcitabine; Raftery et al. explored the combination of oxaliplatin and gemcitabine with concomitant radiotherapy (Abstract #220). As surgical resection still represents the only clear pathway towards cure, data was presented exploring the factors associated with patients who are converted from unresectable to resectable in the locally advanced setting (Abstract #218). The authors summarize and discuss the data from the meeting.
Image: Induction chemotherapy followed by chemoradiotherapy for LAPC: treatment schema from Crane CH et al., 2010.
Downloads
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, 2009. CA Cancer J Clin 2009; 59:225-49. [PMID 19474385] (FULL TEXT: http://caonline.amcancersoc.org/cgi/content/full/59/4/225)
Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969; 2:865-7. [PMID 4186452]
Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeier RJ, Rubin J, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981; 48:1705-10. [PMID 7284971] (FULL TEXT: http://www3.interscience.wiley.com/cgi-bin/fulltext/112671388/PDFSTART)
Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. Gastrointestinal Tumor Study Group. J Natl Cancer Inst 1988; 80:751-5. [PMID 2898536] (FULL TEXT: http://jnci.oxfordjournals.org/cgi/reprint/80/10/751)
Klaassen DJ, MacIntyre JM, Catton GE, Engstrom PF, Moertel CG. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. J Clin Oncol 1985; 3:373-8. [PMID 3973648] (FULL TEXT: http://jco.ascopubs.org/cgi/reprint/3/3/373.pdf)
Huguet F, André T, Hammel P, Artru P, Balosso J, Selle F, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 2007; 20:326-31. [PMID 17235048] (FULL TEXT: http://jco.ascopubs.org/cgi/content/full/25/3/326)
Louvet C, Labianca R, Hammel P, Lledo G, Zampino MG, André T, et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 2005; 23:3509-16. [PMID 15908661] (FULL TEXT: http://jco.ascopubs.org/cgi/content/full/23/15/3509)
Crane CH, Varadhachary GR, Javle MM, Safran H, Krishnan S, Fleming JB, et al. Multi-institutional phase II trial of induction cetuximab, gemcitabine, and oxaliplatin, followed by radiotherapy with concurrent capecitabine, and cetuximab, for locally advanced pancreatic adenocarcinoma (LAPC). 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 132. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=2006)
Shinchi H, Takao S. Phase II study of oral fluoropyrimidine anticancer agent (S-1) with concurrent external-beam radiotherapy for locally advanced pancreatic cancer. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 196. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=2089)
Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakagawa N, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg 2008; 195:757-62. [PMID 18367131] (FULL TEXT: http://www.ajsfulltextonline.com/article/PIIS0002961008000706/fulltext)
Nakamura K, Yamaguchi T, Ishihara T, Sudo K, Kato H, Saisho H. Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer 2006; 94:1575-9. [PMID 16721372] (FULL TEXT: http://www.nature.com/bjc/journal/v94/n11/full/6603168a.html)
Ikeda M, Okusaka T, Ito Y, Ueno H, Morizane C, Furuse J, et al. A phase I trial of S-1 with concurrent radiotherapy for locally advanced pancreatic cancer. Br J Cancer 2007; 96:1650-5. [PMID 17533388] (FULL TEXT: http://www.nature.com/bjc/journal/v96/n11/full/6603788a.html)
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92:205-16. [PMID 10655437] (FULL TEXT: http://jnci.oxfordjournals.org/cgi/content/full/92/3/205)
Moskovic DJ, Carlson PJ, Dakik HK, Qiao W, Javle MM, Fogelman DR. Factors predicting outcomes in patients with locally advanced pancreatic cancer (LAPC). 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 218. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=1276)
Raftery LL, Tepper JE, Goldberg RM, Blackstock AW, Aklilu M, Bernard SA, et al. A phase I study of weekly oxaliplatin (Ox) and gemcitabine (Gem) during radiotherapy (RT) for unresectable pancreatic or biliary carcinoma. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 220. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=1868)
Lawrence TS, Chang EY, Hahn TM, Hertel LW, Shewach DS. Radiosensitization of pancreatic cancer cells by 2',2'-difluoro-2'-deoxycytidine. Int J Radiat Oncol Biol Phys 1996; 34:867-72. [PMID 8598364] (FULL TEXT: http://www.redjournal.org/article/0360-3016(95)02134-5/pdf)
Ikeda M, Okada S, Tokuuye K, Ueno H, Okusaka T. A phase I trial of weekly gemcitabine and concurrent radiotherapy in patients with locally advanced pancreatic cancer. Br J Cancer 2002; 86:1551-4. [PMID 12085203] (FULL TEXT: http://www.nature.com/bjc/journal/v86/n10/full/6600256a.html)
National Comprehensive Cancer Network. Pancreatic Adenocarcinoma V.1.2009. NCCN Clinical Practice Guidelines in Oncology. (FULL TEXT: http://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf)
Morganti AG, Massaccesi M, La Torre G, Caravatta L, Piscopo A, Tambaro R, et al. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol 2010; 17:194-205. [PMID 19856029] (FULL TEXT: http://www.springerlink.com/content/t51u141q14020514/fulltext.html)
Nakachi K, Furuse J, Kinoshita T, Kawashima M, Ishii H, Ikeda M, et al. A phase II study of induction chemotherapy with gemcitabine plus S-1 followed by chemoradiotherapy for locally advanced pancreatic cancer. Cancer Chemother Pharmacol 2009 Dec 5. [PMID 19967537] (FULL TEXT: http://www.springerlink.com/content/l434h23101278049/fulltext.html)
Watanabe F, Honda G, Kurata M, Tsuruta K, Tokashiki T, Funada N. A case report-neoadjuvant chemoradiotherapy with combination of S-1 and gemcitabine in a patient with locally advanced pancreatic cancer. Gan To Kagaku Ryoho 2009; 36:2430-2. [PMID 20037446] (FULL TEXT: http://www.pier-online.jp/0385-0684/contents_abstract.php?serial_no=36120&seq=158)
de la Fouchardière C, Négrier S, Labrosse H, Martel Lafay I, Desseigne F, Méeus P, et al. Phase I study of daily irinotecan as a radiation sensitizer for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2010 Jan 28. [PMID 20116933] (FULL TEXT: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7X-4Y8H3TV-1&_user=606145&_coverDate=01%2F29%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000031398&_version=1&_urlVersion=0&_userid=606145&md5=bb3128962d56c7e8eb3df07f40829633)
Chadha MK, Litwin A, Levea C, Iyer R, Yang G, Javle M, Gibbs JF. Surgical resection after TNFerade therapy for locally advanced pancreatic cancer. JOP. J Pancreas (Online) 2009; 10:535-8. [PMID 19734632] (FULL TEXT: http://www.joplink.net/prev/200909/10.html)
Saif MW. Pancreatic cancer: are we moving forward yet? Highlights from the Gastrointestinal Cancers Symposium. Orlando, FL, USA. January 20th, 2007. JOP. J Pancreas (Online) 2007; 8:166-76. [PMID 17356239] (FULL TEXT: http://www.joplink.net/prev/200703/11.html)
Copyright (c) 2010 Joshua Richter, Muhammad Wasif Saif
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.