Advantage of gemcitabine in the treatment of advanced pancreatic carcinoma.

Introduction. - Pancreatic cancer is one of the most common tumor of the ga strointestinal tract. Current knowledge and key points. - Because this malignant is usually diagn osed at an advanced stage, its prognosis is poor, and patients are generall y considered incurable diagnosis. The traditionnal palliative approach to m anagement of this tumor is chemotherapy. The most widely used agent is 5-FU , alone or in combination. Benefits of the treatment are still poor: the ov erall survival time rarely exceeds 5 months, and no study has shown a respo nse rate greater than 20%. Future prospects and projects.- Gemcitabine, a new antinucleoside agent, ha s led to promising results, as several phase II and III studies have demons trated an increase in survival as compared with 5-FU, the overall 1-year su rvival rates being 18% and 2%, respectively (p < 0002). Furthermore, even i f only discrete results in terms of objective response rate have been achie ved, gemcitabine decreases disease-related symptoms, thus benefiting to the patient's quality of life. The concept of clinical benefit therefore appea rs to be an important judgement criteria in the assessment of chemotherapy efficacy, and will certainly be extended to other malignant neoplasms. (C) 1999 Elsevier, Paris.