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Annals of Oncology Advance Access published online on April 1, 2008
Annals of Oncology, doi:10.1093/annonc/mdn063
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

review

Pancreatic cancer—is the wall crumbling?

Y. J. Chua1 and J. R. Zalcberg2,*

1 The Canberra Hospital, Australian Capital Territory
2 Peter MacCallum Cancer Centre and Department of Medicine, University of Melbourne, Melbourne, Australia

* Correspondence to: Prof. J. Zalcberg, Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne 8006, Australia. Tel: +61-3-9656-1749; Fax: +61-3-9656-1091; E-mail: john.zalcberg{at}petermac.org

In spite of advances made in the management of the other more common cancers of the gastrointestinal tract, significant progress in the treatment of pancreatic cancer remains elusive, more so with the recent negative results of several much anticipated randomized trials. Gemcitabine has been a standard treatment for advanced pancreatic cancer since it was shown a decade ago to result in a superior clinical benefit response and survival compared with bolus 5-fluorouracil (5-FU). Since then, clinical trials have explored the pharmacokinetic modulation of gemcitabine by fixed dose administration and the combination of gemcitabine with other cytotoxics or the biological ‘targeted’ agents. Against a background of numerous negative randomized trials of gemcitabine-based combination treatment, two trials have recently reported modest survival improvements with the use of combination treatment: the United Kingdom National Cancer Research GEMCAP trial of gemcitabine with the orally administered precursor of 5-FU–capecitabine and the National Cancer Institute of Canada Clinical Trials Group PA.3 trial in which the tyrosine kinase inhibitor erlotinib was used with gemcitabine. This review will summarize the results of several recent randomized trials of combination treatment in advanced pancreatic cancer and discuss their implications for clinical practice and for future research in this disease.

Adenocarcinoma, advanced, chemotherapy, gemcitabine, metastatic, pancreas

Received for publication January 6, 2008. Revision received February 13, 2008. Accepted for publication February 14, 2008.


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