Chemotherapy of pancreatic carcinoma

Abstract

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. Until recently, this tumor has not been the subject of a systematic evaluation of nonsurgical therapies. In particular, there have been remarkably few anticancer agents specifically studied for activity in pancreatic cancer, but at the present time 5-fluorouracil, mitomycin-C, streptozotocin, and Adriamycin have demonstrated single-agent effectiveness. Despite the limited number of agents available for the development of combination chemotherapy, several programs have demonstrated an apparent improvement in response relative to single-agent treatment. These include 5-FU and mitomycin-C, SMF, and FAM; response rates of 30-43% have been reported for patients with advanced measurable pancreatic cancer. For the locally advanced stage of this disease, the combined modality approach of 5-fluorouracil plus external irradiation has produced superior survivals when compared with radiation therapy used alone. Although chemotherapy of pancreatic cancer is a developing field, clinically meaningful responses correlated with improved patient survival can be obtained with existing regimens. Phase II trials of new anticancer agents remain a high priority research effort with the intent of identifying useful drugs for future regimens of combination chemotherapy.