Improvement of survival by efficacy orientated sequential poly-chemotherapy of exocrine pancreatic cancer

Results of palliative chemotherapy in 104 patients suffering from exocrine pancreatic carcinomas are presented. First-line therapy included intraarter ial approaches with gemcitabine + mitomycin-C and intravenous systemic trea tments with gemcitabine, gemcitabine + mitomycin-C and oxaliplatin, respect ively. In addition, it was the aim to improve survival by adding second- an d third-line chemotherapies, mainly including high dose 5-FU/FA and irinote can resp. alone or in combinations. Follow-up included clinical investigati ons, imaging methods and determination of tumor markers. Evaluation of effi cacy followed the WHO guidelines. The results indicated the intraarterial l ocoregional treatment of exocrine pancreatic cancer with a combination of m itomycin-C + gemcitabine as a highly effective treatment modality with PR CR of 40% measured by imaging methods and 81% analysed by tumor marker det erminations. The survival analyses suggested relevant prolongation of survi val in relation to the number of effective second- and/or third-line therap ies (0 / 1 / > 1) with median survival - based on the imaging data - of 7, 11 and 20 months for Mo tumors and 3,8 and 14 months for tumor diseases wit h liver metastases at time of admission respectively. Relevant precondition s for second- and/or third-line therapies of pancreatic carcinomas are give n by more or less effective first-line treatment modalities of this cancer disease on the one hand and by the actual diagnostic aids allowing the begi nning of first-line therapy as well as the detection of recurrence early en ough to by a second- or third-line therapy before clinical/ethical aspects prevent further antitumoral treatment trials in the individual patient.