CHEMOTHERAPY FOR PANCREATIC-CARCINOMA

BACKGROUND. Pancreatic cancer is an aggressive disease and its patient s typically have a short survival, usually marked by pain and rapid de bilitation. The disease has been considered relatively chemoresistant, although many chemotherapy regimens have been described. METHODS. Cli nical results with chemotherapy, since the first publication of respon se in 1960, were reviewed for efficacy and toxicity. Emphasis was give n to prospective trials with adequate power and clear evaluation crite ria and endpoints. RESULTS. Published response rates vary enormously i n this disease, with rates in earlier single-institution trials tendin g to be much higher than those in studies with stringent response crit eria, particularly recent cooperative group trials. Using stringent cr iteria, the upper limit of the objective response rate is approximatel y 20%. No convincing improvement in median survival can vet be attribu ted to chemotherapy. Few trials have measured quality of life, but sym ptomatic palliation rates may exceed objective response rates. Some lo w-toxicity regimens (such as those based on infusional 5-FU) yield res ponse rates as high as some more toxic combinations. CONCLUSIONS. Many early trials significantly overstate the efficacy of chemotherapy for patients with pancreatic cancer, apparently due to flexibility of res ponse criteria. However, useful symptomatic palliation map occur even without an objective partial response. It is possible that slow resolu tion of the desmoplastic component of these tumors may underestimate t umor killing. Thus, quality of life is an important parallel endpoint (with survival and response) in chemotherapy trials in this disease. ( C) 1996 American Cancer Society.