What's new in therapy of pancreatic cancer?

Pancreatic cancer remains a dismal disease with a median survival after diagnosis of about 6 months.

Clinical trials with regard to treatment of pancreatic cancer, published as full manuscripts within the last 3 years and available via PubMed, were evaluated.

Several factors have positive influences on survival after pancreas resection: well-differentiated tumor grade, low tumor size, no duodenal or major vessel invasion, no perineural invasion, negative lymph node status, resection margin negativity (R0), high-volume centers, presence of human equilibrative nucleoside transporter 1 in patients treated with gemcitabine, low preoperative tumor marker CA 19-9, and low bilirubin level. The following factors seem to have no influence on survival after pancreas resection: age, blood loss and transfusion requirements following resection, location of tumor, and type of resection. Adjuvant chemotherapy after R0 resection is standard: gemcitabine seems to be superior to 5-FU or no therapy. Nevertheless, only a few patients survive for at least 5 years after R0 resection and adjuvant chemotherapy. Most patients need palliative treatment. Besides best supportive care including nutritional support, therapy for pain and endoscopic treatment of jaundice, gemcitabine is standard in both locally advanced and metastatic disease. The addition of the tyrosine kinase inhibitor erlotinib prolongs median survival for only 2 weeks. Erlotinib has only beneficial effects in patients who develop a skin rash. None of the studied combinations of various therapies have demonstrated any additional benefits.

There are no real medical breakthroughs with regards to improving the prognosis of pancreatic cancer.