Department of Clinical Oncology,
The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong
Kong.
[Record supplied by publisher]
OBJECTIVE: To review the
systemic chemotherapy regimens for pancreatic cancer. DATA SOURCES: Medline and
non-Medline literature search (1966-1999). STUDY SELECTION: The following key
words were used: pancreatic carcinoma; chemotherapy; antineoplastic agent;
fluorouracil; gemcitabine. DATA EXTRACTION: Reports of phase II studies,
randomised controlled studies, and preclinical studies were reviewed. DATA
SYNTHESIS: Less than 20% of patients are suitable candidates for surgery; for
the remainder, palliative chemotherapy is of only marginal benefit. Combining
fluorouracil with folinic acid or interferon has not led to any significant
improvement in tumour response or the patient survival rate. The early
encouraging results with combination chemotherapy have not been confirmed in
subsequent controlled studies. New approaches include immunotherapy and novel
cytotoxic drugs. In vitro studies of monoclonal antibodies have shown promise
but have failed to show clinical efficacy. Recently, gemcitabine has been shown
to be more effective than fluorouracil in delivering pain relief and reducing
disease-related symptoms. CONCLUSION: Systemic chemotherapy is generally
ineffective in increasing the survival time of patients with pancreatic cancer.
Future clinical investigations concerning treatment should focus on
gemcitabine-based combination chemotherapy or combined modality treatment with
radiotherapy.
