A systematic overview of chemotherapy effects in pancreatic cancer

A systematic review of chemotherapy trials in several tumour types was perf ormed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are describ ed separately (Acta Oncol 2001: 40: 155-65). The conclusions of this overvi ew in pancreatic cancer are based on 10 randomised studies with, and 18 ran domised studies without. an untreated control group. Altogether. 4028 patie nts were included in the phase III studies. Furthermore, 32 phase II studie s or retrospective analyses including 1404 patients have been evaluated. Th e conclusions reached can be summarized into the following points: There is no convincing evidence that pancreatic cancer patients benefit fro m adjuvant chemotherapy treatment, with or without concomitant radiotherapy . Adjuvant chemotherapy in patients with pancreatic cancer should thus not be used routinely. In locally advanced/metastatic pancreatic cancer, six randomised trials com paring combination chemotherapy with an untreated control group were retrie ved. In three trials, two of which were performed recently. chemotherapy pr ovided statistically significant prolongation in median survival in the ran ge of three to nine months. The three other trials, all reported in the ear ly 80s. essentially showed no difference in survival between the treatment groups. In the locally advanced/metastatic setting there are also several randomise d trials comparing various chemotherapy regimens. Except for an improvement in median survival of one to two months from gemcitabine compared with 5-F U. no differences were observed. There is no convincing evidence that a large fraction of pancreatic cancer patients will benefit from palliative chemotherapy. The few open-design stu dies that have explored the influence on symptom relief/quality of life ind icate that between 20-35% of the patients get clinical benefit, but usually short-lived. Recently performed randomised studies, all using adequate methodology, indi cate that the beneficial effects observed in advanced pancreatic cancer are similar to those of accepted therapy in other cancer types. However, due t o the limited positive effects. palliative chemotherapy in pancreatic cance r can only be recommended selectively and should preferably be used within controlled clinical trials exploring new treatment combinations or concepts .