Effective Treatment of Pancreatic Cancer Remains Elusive

"Although therapeutic strategies have advanced for many common gastrointestinal cancers, significant progress in the treatment of pancreatic cancer remains elusive. The eagerly anticipated results of randomized trials that evaluated gemcitabine-based combination regimens have proven to be disappointing, researchers report in a review paper that discusses the use of systemic therapy in advanced pancreatic cancer. Whereas 2 recent trials have demonstrated a modest survival benefit with combination therapy, some consider the improvement to be too small to justify the risk of toxicity or added cost.
The article appears in the July issue of the Annals of Oncology.

"Not many trials have been promising, unfortunately, as this is a difficult disease," said coauthor John R. Zalcberg, MD, PhD, professor and director of the division of haematology and medical oncology at the Peter MacCallum Cancer Institute, in Melbourne, Australia. "The new biologics have really not, at this point, been as hopeful as we would have liked or expected."

One disappointment has been the negative results from trials combining bevacizumab (Avastin, Roche) and gemcitabine (Gemzar, Eli Lilly), especially because an early-phase study showed a survival benefit. "We were hoping that it would be the opening of a new treatment era for pancreatic cancer, but unfortunately, that hasn't happened," Dr. Zalcberg told Medscape Oncology.

Pancreatic cancer is the eighth most common cause of cancer death; even with treatment, less than 5% of patients survive 5 years. This disease presents a number of challenges that the clinician has to consider and that make effective therapy so difficult, the authors point out. It is frequently diagnosed at a late stage, often after it has metastasized, and disease-related symptoms, including pain and cachexia, negatively affect performance status and limit the safe delivery of treatment.

The disease is highly resistant to chemotherapy, and systemic treatments produce only modest benefits. Only about 10% to 15% of patients have tumors that can be surgically resected; even then, the risk for recurrence is high. However, it is possible that adjuvant therapy will improve outcomes in this population as new strategies are developed."