Chemotherapy of adenocarcinoma of the pancreas

Adenocarcinoma of the pancreas is the fifth leading cause of cancer death in the United States. Although surgery and radiation therapy may improve prognosis in patients with localized and resectable tumors, chemotherapy has produced minimal benefit. Patients with unresectable and/or metastatic pancreatic cancer are most frequently treated with 5-fluorouracil-based regimens which have produced little palliation with no improvement in overall survival. Newer treatment modalities including octreotide, biologic response modifiers, and monoclonal antibodies have been explored and have resulted in some minor responses. Other chemotherapeutic agents such as the taxanes (ie, paclitaxel and docetaxel) have not been fully evaluated. Initial evaluations of paclitaxel and docetaxel have shown less than 20% response rates. Attempts at dose escalation with growth factor support are also being pursued. The most exciting new agent being tested currently in pancreatic cancers is gemcitabine which has produced overall clinical benefits in as many as 25% of cases.