Chemotherapy of pancreatic carcinoma

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. Until recently, this tumor has not been the subject of a systematic evaluation of nonsurgical therapies. In particular, there have been remarkably few anticancer agents specifically studied for activity in pancreatic cancer, but at the present time 5-fluorouracil, mitomycin-C, streptozotocin, and Adriamycin have demonstrated single-agent effectiveness. Despite the limited number of agents available for the development of combination chemotherapy, several programs have demonstrated an apparent improvement in response relative to single-agent treatment. These include 5-FU and mitomycin-C, SMF, and FAM; response rates of 30-43% have been reported for patients with advanced measurable pancreatic cancer. For the locally advanced stage of this disease, the combined modality approach of 5-fluorouracil plus external irradiation has produced superior survivals when compared with radiation therapy used alone. Although chemotherapy of pancreatic cancer is a developing field, clinically meaningful responses correlated with improved patient survival can be obtained with existing regimens. Phase II trials of new anticancer agents remain a high priority research effort with the intent of identifying useful drugs for future regimens of combination chemotherapy.