Pancreatic Cancer

Early clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.

The combination of irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) produced a 1-year survival rate of 27%, which is greater than that reported for gemcitabine alone in previous studies in patients with advanced pancreatic cancer (15% and 18% 1-year survival rates, respectively). These study results were published in a recent issue of the Journal of Clinical Oncology (20:1182-1191, 2002).

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.

Lorus Therapeutics announced recently that it has initiated a phase III trial to evaluate the macrophage activator Virulizin for the treatment of advanced pancreatic cancer. The company will present the results of this trial to the US Food and Drug Administration (FDA) in a new drug application at the completion of the study.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

The article by Drs. Levy and Wiersema is an excellent overview of the indications, technical nuances, and efficacy of endoscopic ultrasound in the diagnosis and staging of pancreatic neoplasms. Endoscopic ultrasonography was introduced into the diagnostic armamentarium for gastroenterology approximately 15 years ago. Although the literature suggests a general increase in the utility and experience with endoscopic ultrasound, the technique remains most effective in the hands of experienced experts like Drs. Levy and Wiersema. Their article is a complete and thorough review of the indications and expected accuracy of the technique when evaluating a variety of different pancreatic lesions.

Two decades have elapsed since publication of the first papers describing the examination of the pancreas via the stomach and the duodenum using an ultrasound probe fixed to an endoscope tip. Initial attempts to image the pancreas in this fashion proved difficult and frustrating, but they were promising enough that instrument makers and gastrointestinal endoscopists persisted in developing increasingly effective devices.

Patients with signs and symptoms suggestive of a pancreatic neoplasm typically undergo initial imaging with transabdominal ultrasound or computed tomography. This evaluation often reveals the presence of a pancreatic mass or fullness.

Drs. Levy and Wiersema have provided an authoritative review of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. As outlined in their article, endoscopic ultrasound has emerged as an important tool in the diagnostic evaluation of many patients with suspected pancreatic neoplasms. We concur that endoscopic ultrasound is part of the standard preoperative evaluation of patients with biochemically confirmed insulinoma and gastrinoma syndromes and of at-risk patients with multiple endocrine neoplasia type 1. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration (FNA) can also accurately determine the etiology of a cystic pancreatic neoplasm by differentiating between mucinous, serous, and inflammatory (pseudocyst) lesions.

SAN FRANCISCO-Two phase II chemotherapy regimens combining gemcitabine (Gemzar) and docetaxel (Taxotere) in patients with advanced pancreatic cancer show higher response rates than gemcitabine alone and suggest further explorations of the combination are warranted, according to presentations at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO).

SAN FRANCISCO-In patients with advanced pancreatic cancer, the combination of gemcitabine (Gemzar) followed by oxaliplatin (investigational in the United States) (GEMOX) is active with low toxicity, Christophe Louvet, MD, Hôpital St-Antoine, Paris, France, said at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 506).

SAN FRANCISCO-Two studies presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO) show no advantage to adding fluorouracil (5-FU) to gemcitabine (Gemzar) in patients with advanced pancreatic cancer.

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

WINSTON-SALEM, North Carolina-Preliminary data from a phase II trial of induction irinotecan (Camptosar)/gemcitabine (Gemzar) followed by twice-weekly gemcitabine and radiation in patients with locally advanced pancreatic cancer show partial responses in 2 of 7 evaluable patients. There were no local progressions, and median time to progression of 6 months, according to A. William Blackstock, MD. Dr. Blackstock is assistant professor at Wake Forest University, Winston-Salem, North Carolina, and at the University of North Carolina at Chapel Hill.

SAN FRANCISCO-In an effort to extend the activity of gemcitabine (Gemzar) against pancreatic cancer, researchers have paired an investigational chimeric monoclonal antibody, IMC-C225 (cetuximab) with the standard chemotherapy. IMC-C225 selectively binds to epidermal growth factor receptor (EGFR).

TAMPA, Florida-Phase II studies have shown that the combination of irinotecan (Camptosar) and gemcitabine (Gemzar) are well tolerated and active in advanced or metastatic pancreatic cancer, and this combination is now being tested in randomized phase II and phase III trials, said Caio Max S. Rocha Lima, MD. Dr. Rocha Lima is assistant professor of medicine at the University of South Florida’s H. Lee Moffitt Cancer Center in Tampa, Florida.

BMS-247550 is a methyl, semi-synthetic analog of the natural product epothilone B. Provided to the National Cancer Institute (NCI) by Bristol-Myers Squibb, BMS-247550 was chosen for clinical development because it demonstrated

Given the well-established role of angiogenesis (or new blood vessel formation) in tumor growth and metastasis, antiangiogenic therapy, a concept first proposed by Dr. Judah Folkman,[1] has become increasingly recognized as a promising

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local

The article entitled "Neoadjuvant Strategies for Pancreatic Cancer," by Drs. Evans, Wolff, and Crane, is an excellent review of past and current developments in adjuvant therapy for pancreatic cancer. In addition to a thorough literature review, the authors draw on their own extensive experience in neoadjuvant therapy for pancreatic cancer at M. D. Anderson Cancer Center.

We have made much progress over the past 30 years in the surgical management of pancreatic cancer, and perioperative mortality rates are low in centers with experience in the treatment of this disease. However, surgical resection is clearly limited in achieving local and systemic control of pancreatic cancer, and chemoradiation will likely become a part of any successful pancreatic cancer treatment program.

This report by Drs. Evans, Wolff, and Crane is a well-written and concise description of their extensive experience with the treatment of pancreatic cancer. They and others at the M. D. Anderson Cancer Center should be congratulated for their innovative, methodical, and thoughtful approach to the treatment of this lethal disease.

Recent prospective and retrospective data suggest that the use of multimodality therapy combining pancreaticoduodenectomy with postoperative adjuvant chemotherapy (fluorouracil) and external-beam radiation

NEW YORK-The camptothecin analog rubitecan (9-nitrocamptothecin) is safe and active in advanced pancreatic cancer, the combined experience from two phase II trials suggests.