PANCREATIC CANCER
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Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database.
Sener SF, Fremgen A, Menck HR, Winchester DP.
J Am Coll Surg 1999 Jul;189(1):1-7.The results of this study indicate that survival rates of patients with pancreatic cancer have not changed in the past two decades. The study was conducted on a group of over 100,000 patients who were diagnosed with pancreatic cancer during the period 1985-1995. The only survival advantage was noticed in patients with limited or advanced disease who underwent surgery, compared to those who did not. These data indicate that treatments other than surgery have been ineffective in the management of pancreatic cancer.
Randomized study of 5-FU and CCNU in pancreatic cancer
Report of the Veterans Administration Surgical Adjuvant Cancer Chemotherapy Study Group.
Frey C; Twomey P; Keehn R; Elliott D; Higgins G.
Cancer, 47(1):27-31 1981 Jan 1.The results of this study show that combination chemotherapy with 5-FU and CCNU does not improve survival in patients with advanced pancreatic cancer. Average survival in patients randomized to receive chemotherapy was 3.0 months, while that of patients who did not receive any treatment was 3.9 months. Patients experienced toxic reactions during one-third of chemotherapy courses.
Intensive weekly chemotherapy is not effective in advanced pancreatic cancer patients
A report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD).
Cascinu S; et al.
Br J Cancer, 79(3-4):491-4 1999 Feb.The results of this study show that intensive combination chemotherapy does not stop the progression of disease nor improve survival in patients with advanced pancreatic cancer, while being associated with significant toxicity.
Review article: current treatment and optimal patient management in pancreatic cancer.
Haycox A; Lombard M; Neoptolemos J; Walley T.
Aliment Pharmacol Ther, 12(10):949-64 1998 Oct.This review article emphasizes that there is no valid evidence indicating that chemotherapy is effective in prolonging survival in patients with pancreatic cancer. Most trials have shown low tumor response rates and short duration of response, with no significant effects on survival.
Chemotherapy for pancreatic carcinoma.
Ahlgren JD.
Cancer 1996 Aug 1;78(3 Suppl):654-63.This study reviewed all articles published since 1960 on the efficacy of chemotherapy in the treatment of patients with pancreatic cancer. The earlier articles reported higher tumor responses to chemotherapy, compared to the later ones. This was due mainly to the flexibility of the criteria used to judge a tumor response. Using stricter criteria, the maximum rate of tumor shrinkage observed in response to various chemotherapy regimens was 20%. High-toxicity regimens produced same rate of responses than low-toxicity ones. Regardless of the regimen, however, tumor responses did not result in improved survival.
Adjuvant chemotherapy in pancreatic cancer.
Bramhall SR, Neoptolemos JP.
Int J Pancreatol 1997 Feb;21(1):59-63.This article highlights that currently, there is no evidence supporting the use of adjuvant chemotherapy in patients with pancreatic cancer. Several studies have been published describing the effectiveness of chemotherapy in the management of this disease; however, only one was randomized and included a small sample of patients. This study showed increased average survival in patients receiving chemotherapy compared to those who did not (23 months vs. 11 months) but reduced 5-year survival (4% vs. 8%). The authors conclude that until larger randomized trials are performed, use of adjuvant chemotherapy cannot be recommended for patients with pancreatic cancer.
Chemotherapy in the treatment of cancer of the pancreas.
Glimelius B.
J Hepatobiliary Pancreat Surg, 5(3):235-41 1998.This study conducted a systematic review of the published literature to elucidate the role of chemotherapy in the treatment of patients with pancreatic cancer. Eight randomized trials were analyzed in which rates of survival in patients treated with chemotherapy were compared to those of patients who received no treatment. All trials were small, and not always methodologically correct. The authors found no conclusive evidence indicating that chemotherapy improves survival in patients with pancreatic cancer.
A phase II study of temozolomide in advanced untreated pancreatic cancer.
Moore MJ; Feld R; Hedley D; Oza A; Siu LL.
Invest New Drugs, 16(1):77-9 1998.The results of this study show that the anticancer drug temozolomide, used in patients with skin and brain tumors, is ineffective in patients with pancreatic cancer. Fifteen patients with previously untreated pancreatic cancer received the drug. No tumor responses were observed, and disease progressed in 14 patients during the 2 months following treatment. Severe adverse reactions were observed primarily in the blood system, with decreased number of white blood cells and platelets, resulting in increased risks of infections and hemorrhage.
Seventy-two hour epirubicin infusion plus quinidine in unresectable and metastatic adenocarcinoma of the pancreas: a phase II trial.
Abad A, et al.
Am J Clin Oncol, 21(2):151-4 1998 Apr.This study shows that treatment with high doses of the anticancer drugs epirubicin and quinidine is ineffective in the management of advanced pancreatic cancer. Twenty-two previously untreated patients received continuous infusion of the two drugs. No improvement in survival or quality of life was observed in these patients.
Isolated hypoxic perfusion with mitomycin C in patients with advanced pancreatic cancer.
Lorenz M, et al.
Eur J Surg Oncol, 24(6):542-7 1998 Dec.This study was undertaken to evaluate the role of regional chemotherapy in patients with advanced pancreatic cancer. While the results obtained from systemic chemotherapy have been disappointing, some authors reported prolonged survival in patients receiving chemotherapy delivered directly to the pancreas in the attempt to reduce systemic toxicity. Seventeen patients with advanced pancreatic cancer received local infusion of the anticancer drug mitomycin C. No tumor responses were observed. Nausea and vomiting were frequent. Thirty percent of patients developed deep venous thrombosis. No improvement in disease-free or overall survival was observed. The results of this study do not support use of regional chemotherapy in patients with advanced pancreatic cancer.
5-fluorouracil continuous infusion combined with cisplatin for advanced pancreatic cancer: a Japanese Cooperative Study.
Nose H, et al.
Hepatogastroenterology 1999 Nov-Dec;46(30):3244-8.This study evaluated the effects of a chemotherapy regimen consisting of 5-fluorouracil and cisplatin in patients with advanced pancreatic cancer. Thirty-seven patients with untreated pancreatic cancer received the combination protocol. Partial tumor shrinkage was observed in 8% of patients. Average survival was 5 months. Nausea and vomiting were the most frequently observed signs of toxicity. The authors concluded that this regimen is ineffective and should not be used in patients with pancreatic cancer.
Phase I trial of gemcitabine (Gemzar), 24 h infusion 5-fluorouracil and folinic acid in patients with inoperable pancreatic cancer.
Oettle H, et al.
Anticancer Drugs 1999 Sep;10(8):699-704.This study evaluated the effects of combination chemotherapy with gemcitabine, 5-fluorouracil and folinic acid in the treatment of 16 previously untreated patients with pancreatic cancer. One patient died of treatment-related liver and kidney failure. Only one tumor response was observed. Performance status improved in 13 patients.
Experimental drugs and drug combinations in pancreatic cancer.
Kroep JR, Pinedo HM, van Groeningen CJ, Peters GJ.
Ann Oncol 1999;10 Suppl 4:234-8.This article highlights that chemotherapy has only a limited role in the management of pancreatic cancer. 5-fluorouracil and gemcitabine are the drugs commonly used as single agents or in combination regimens, but rates of tumor responses are lower than 15% and the overall impact on survival is minimal.
Adjuvant therapy for pancreatic cancer.
Ghaneh P, Kawesha A, Howes N, Jones L, Neoptolemos JP.
World J Surg 1999 Sep;23(9):937-45.This article highlights that survival in patients with pancreatic cancer has not shown major improvements throughout the years, and that the role of chemotherapy as conventional treatment for the management of this disease is yet to be established.
Phase II study of docetaxel in patients with metastatic pancreatic cancer: a Japanese cooperative study.
Cooperative Group of Docetaxel for Pancreatic Cancer in Japan.
Okada S, Sakata Y, Matsuno S, Kurihara M, Sasaki Y, Ohashi Y, Taguchi T.
Br J Cancer 1999 May;80(3-4):438-43.This study was undertaken to confirm previous findings reporting promising results from the use of the anticancer drug docetaxel in patients with pancreatic cancer of the ductal type. Twenty-one, previously untreated patients were enrolled and started receiving the treatment. No tumor responses were observed. Overall, patients survived an average of 118 days. Toxicity included blood system toxicity, with seriously decreased number of white blood cells, red blood cells and platelets; nausea and vomiting; loss of appetite; malaise and fatigue, and loss of hair. The results of this study indicate that docetaxel has no effects on tumor progression and is associated with significant toxicity in patients with pancreatic cancer.
A phase II trial of etoposide, folinic acid, fluorouracil and epirubicin in advanced pancreatic carcinoma.
Maiello E, Gebbia V, Giuliani F, Testa A, Giotta F, Gebbia N, Colucci G.
Clin Ter 1998 Sep-Oct;149(5):351-5.This study was undertaken on the basis of preliminary studies reporting encouraging results in patients with advanced pancreatic cancer treated with combination chemotherapy regimens including etoposide, folinic acid, 5-fluorouracil, and epirubicin. Twenty-three patients were enrolled. Tumor responses were observed in 15% of patients. Median survival was 5 months. Toxicity included diarrhea, inflammation of various mucosae, and decreased number of white blood cells leading to increased risk of infections.
Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas.
White R, et al.
Ann Surg Oncol 1999 Jan-Feb;6(1):38-45.This article shows that chemotherapy and radiation therapy administered to patients with locally advanced pancreatic cancer in the attempt of reducing tumor size for better surgical removal of the tumor, are not associated with any significant advantage to the patient.
Intensive weekly chemotherapy is not effective in advanced pancreatic cancer patients
A report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD).
Cascinu S, et al.
Br J Cancer 1999 Feb;79(3-4):491-4.The results of this study show that a combination chemotherapy regimen consisting of weekly administrations of cisplatin, 5-fluorouracil, epidoxorubicin, 6S stereoisomer of leucovorin, and glutathione, in patients with advanced pancreatic cancer, is associated with low tumor response rates (13%), and no effects on survival. These results do not support use of this combination regimen in the management of patients with advanced pancreatic cancer.
Prospective randomized trial of 5-fluorouracil, doxorubicin, and mitomycin C for non-resectable pancreatic and biliary carcinoma: multicenter randomized trial.
Takada T, et al.
Hepatogastroenterology 1998 Nov-Dec;45(24):2020-6.This study evaluated the effects of a combination chemotherapy regimen in patients with advanced pancreatic and biliary cancer. Eighty-three patients were randomized to receive surgery only (41 patients) or surgery followed by chemotherapy consisting of fluorouracil, doxorubicin and mitomycin. No differences in survival were observed between the two groups. Adverse reactions in patients receiving chemotherapy included diarrhea, nausea, vomiting, loss of appetite, and loss of hair.
ALTERNATIVE TREATMENTS FOR PANCREATIC CANCER
Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support.
Gonzalez NJ, Isaacs LL.
Nutr Cancer 1999;33(2):117-24.The results of this study show that treatment consisting of high doses of pancreatic enzymes, detoxification procedures, organic diet and nutritional supplements, is associated with significant increased survival in patients with advanced pancreatic cancer (stage II through stage IV). The study was conducted on 11 patients with pancreatic cancer confirmed at histological analysis. They followed the aforementioned protocol while being at home, under the supervision of a physician. Survival rates were 81% at 1 year (9 patients), 45% at 2 years (5 patients), and 36% (4 patients) at 3 years. Two patients were currently being alive while the article was being written, one at 3 years from diagnosis, and the other at 4 years. Survival rates in these patients were dramatically higher than those reported for patients with all stage pancreatic cancer (25% survival at one year and 10% survival at two years).
The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer.
Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KC.
Br J Cancer 1999 Sep;81(1):80-6.The results of this study indicate that diet supplementation with fish oil can stop the progression of cachexia (a profound and marked state of general ill health where the individual progressively loses weight and becomes severely malnourished) and promotes weight gain in patients with advanced pancreatic cancer. The study was conducted on 20 patients with pancreatic cancer who had been losing weight at a rate of approximately 3 kg per month. They were asked to consume each day supplemental food enriched with 2.2 grams of eicosapentaenoic acid (essential fatty acids) from fish oil. Previous studies reported no improvement in patients who were given standard oral food supplements. After the first three weeks of treatment, patients gained an average of 1 kg, and after 7 week of treatment, they gained an average of 2 kg. Food intake, performance status, and appetite were also significantly increased. These data indicate that fish oil supplementation may have an important role in the management of patients with pancreatic cancer.
Fatty acids for treating pancreatic cancer. Letter.
Wigmore, S J, et al.
BMJ 1994;309:544 (20 August).This article emphasizes that there is sound scientific evidence in support of the hypothesis that essential fatty acids may increase survival in patients with advanced pancreatic cancer. The disease is associated with significant weight loss that is not prevented by increased nutritional intake. It is believed that the production of acute phase proteins by the liver is partly responsible for the weight loss. Essential fatty acids inhibit the production of these proteins. According to the results of experimental studies, weight loss is significantly reduced in animals with cancer whose diet is supplemented with essential fatty acids. Since weight loss and malnutrition considerably increase morbidity and mortality in patients with pancreatic cancer, essential fatty acids have a potentially important role in the management of this condition. The authors also note that these natural-occurring substances have no side effects, which is important in patients with limited life expectancy.
Fish oil-enriched nutritional supplement attenuates progression of the acute-phase response in weight-losing patients with advanced pancreatic cancer.
Barber MD, Ross JA, Preston T, Shenkin A, Fearon KC.
J Nutr 1999 Jun;129(6):1120-5.This study evaluated the effects of fish oil supplementation in patients with pancreatic cancer. Laboratory studies have shown that fatty acids contained in fish oil alter the production of acute-phase proteins, a class of protein believed to induce weight loss in patients with pancreatic cancer and shorten their survival. Fish oil supplements were administered for 3 weeks to 18 consecutive patients with pancreatic cancer, while another 18 patients received supportive care only (control group). Levels of acute-phase proteins increased in the control group and stabilized in the fish oil group. These results suggest that fish oil may have a role in reducing wasting (progressive weight loss) in patients with pancreatic cancer.
Anticachectic and antitumor effect of eicosapentaenoic acid and its effect on protein turnover.
Beck SA, Smith KL, Tisdale MJ.
Cancer Res 1991 Nov 15;51(22):6089-93.The results of this study show that supplementation with the essential fatty acid eicosapentaenoic acid (EPA) inhibits weight loss and halts tumor growth in mice with colon cancer. These effects increase with increasing doses of essential fatty acid intake, and optimal responses are observed for EPA doses of 1.25-2.5 g/kg. Survival of animals supplemented with optimal EPA dosage is approximately doubled, compared to the established survival rates of animals with cancer.
Effect of eicosapentaenoic acid and other fatty acids on the growth in vitro of human pancreatic cancer cell lines.
Falconer JS, Ross JA, Fearon KC, Hawkins RA, O'Riordain MG, Carter DC.
Br J Cancer 1994 May;69(5):826-32.The results of this study show that essential fatty acids inhibit the growth of pancreatic cancer cell lines. Three pancreatic cancer cell lines were incubated with different concentrations of distinct polyunsaturated fatty acids. All of them had tumor growth inhibitory effects, but eicosapentaenoic (EPA) acid was the most effective. These data suggest that supplementation with EPA may have therapeutic benefits on patients with pancreatic cancer.
