Chemotherapy for patients with adenocarcinoma of the pancreas

Adenocarcinomas of the pancreas are diagnosed at an advanced, non-curable stage in most patients. In addition to local relapse or progression, distant metastases determine the poor prognosis, resulting in a median survival of less than 6 months in most studies of patients with locally advanced or metastatic pancreatic cancer. None of the cytotoxic drugs available show impressive activity in treatment of this disease. Therefore, chemotherapy is not recommended in pancreatic cancer. In selected cases, 5-fluorouracil-based therapy - with or without simultaneous radiation - may result in tumor responses. With a once-a-week outpatient protocol of folinic acid and 5-fluorouracil, we observed a progression-free period from 15 to 42 weeks in nine of 19 patients treated without any serious adverse effects, confirming reports of the weak, but well-tolerated activity of this combination. To alter the prognosis for patients with advanced adenocarcinomas of the pancreas, new drugs with more activity have to be developed and tested in well-designed trials.