[Current aspects of chemotherapy of metastatic pancreatic and biliary tract carcinomas]

Abstract

More than 50% of patients with pancreatic or biliary tract cancer are diagnosed in advanced and curatively unresectable tumor stages. To date, chemotherapeutic treatment yielded disappointing results in these patients with 5-year survival rates of 0-15%, leading to therapeutic nihilism in many patients. However, with the availability of new cytostatic agents as well as the introduction of the novel clinical endpoint "clinical benefit response" at least some improvements may be possible in patients with pancreatic cancer. Several randomized studies have shown a clinical and survival benefit for patients treated with chemotherapy as compared to patients treated with best supportive care alone. Gemcitabine was the first agent, which was investigated for its potential to improve symptoms as well as overall well being. A significant clinical benefit response can be achieved in up to 40% of patients with advanced pancreatic cancer. Gemcitabine is currently also investigated in combination chemotherapy regimens. First results with combination chemotherapy regimens such as cisplatin/gemcitabine have shown promising results. In addition, taxanes such as docetaxel also appear to have a certain activity in patients with pancreatic cancer. In contrast, topoisomerase I-inhibiting drugs seems to have no efficacy in the treatment of this disease. New and experimental therapeutic options such as angiogenesis-inhibition, matrixmetalloproteinase-inhibition or the use of monoclonal antibodies are currently evaluated within clinical studies. Only a few small studies reporting about chemotherapy in patients with biliary tract cancer have been published. This is mainly due to the rarity of this tumor entity, but also due to the rapid onset of symptoms such as hyperbilirubinemia, which will limit the number of potentially available drugs. 5-FU is the most widely investigated drug inducing remissions in 10-15% of patients. It is unclear whether new agents such as gemcitabine or the taxanes will led to an improvement of the prognosis of these patients. Although the recent advances in the treatment with these new therapeutic options are far from being satisfactory, it appears that a first small step ahead has been made the treatment of these diseases.