review of literature on clinical pancreatology - The Pancreapedia

A 67-year-old male with pancreatic cancer (cStage IVb) was given gemcitabine on days 1, 8and 15, and this was repeated on 29 days at dose <strong>of</strong> 800 mg/m(2) in outpatient clinic. After 2courses, he suffered from dyspnea and fever. Laboratory examination showed that theserum levels <strong>of</strong> white cell count, C-reactive protein, lactate dehydrogenase and KL-6 wereelevated. Chest X-ray and CT revealed diffuse bilateral interstitial infiltrates. He wasdiagnosed with drug induced interstitial pneumonia due to gemcitabine. Corticosteroidtherapy consisting <strong>of</strong> methylprednisolone (1,000 mg/day) for three days followed byprednisolone was effective and he was discharged on the 29th day after admission. Acutepulmonary toxicity induced by gemcitabine could lead to severe complication [536].Gemcitabine plus cisplatinThe antitumor activity and toxicity <strong>of</strong> a multi-step treatment were evaluated in patients withlocally advanced, inoperable, or incompletely resected adenocarcinomas in 54 patients, 63percent with pancreatic cancer and 37 percent with biliary tract tumors. The patients received3 courses <strong>of</strong> cisplatin-gemcitabine induction chemotherapy. Progression-free (PF) patientswere given consolidation radiotherapy with concurrent capecitabine. PF patients had, asmaintenance immunotherapy interleukin 2 (1.8 x 106 IU) and 13-cis-retinoic acid (5 mg/kg).Thirty-eight patients, 27 with pancreatic and 11 with biliary tract adenocarcinomas, PF aftercisplatin/gemcitabine, were treated with consolidation radiotherapy with concurrentcapecitabine. Fourteen progressive free patients, 7 with pancreatic and 7 with biliary tractcancers, received maintenance immunotherapy. Median PF and overall survivals (OS) for all54 patients were 7 and 12 months, respectively. Patients treated with maintenanceimmunotherapy had a median PF survival <strong>of</strong> 16 months, whereas median OS had not beenreached yet, after a median follow-up <strong>of</strong> 28 months. Toxicity grades 3 and 4 forhematological and gastrointestinal was seen in 30 and 37 percent <strong>of</strong> patients, respectively;grades 1 and 2 autoimmune reactions were seen in 28 percent <strong>of</strong> patients. It was concludedthat these results support the efficacy and safety <strong>of</strong> a multi-step sequential treatment inpatients with locally advanced, inoperable or incompletely resected pancreatic and biliarytract adenocarcinomas [537].Gemcitabine plus S-1The patient was a 54-year-old male. He underwent resection <strong>of</strong> the pancreatic body tailregion to treat pancreatic body tail cancer. On histopathological examination, the stump <strong>of</strong>the extirpated specimen was positive for tumor cells. After surgery, 10 courses <strong>of</strong> therapywith gemcitabine hydrochloride (GEM, 1, 000 mg/m 2 , 3-week administration followed by 1-week discontinuation) were performed, and follow-up was continued. When a local relapsewas detected chemotherapy with GEM was administered for 1 year and 9 months. However,when an increase in the recurrent lesion size and right lung metastasis were noted theregimen was switched to combination therapy with S-1 and GEM (S-1 60 mg/m 2 day,continuous administration on days 1 to 14 and 2-week discontinuation; and GEM 1, 000 mg/m 2 , administered on days 8 and 15). After the end <strong>of</strong> the 11th course, PET-CT revealed thedisappearance <strong>of</strong> FDG accumulation in the recurrent and metastatic lesion sites. During thetreatment period, there were no grade 3 or higher adverse reactions [538].A retrospective study aimed to evaluate the anti-tumor activity and toxicity <strong>of</strong> combinationchemotherapy with gemcitabine (GEM) and oral S-1 or UFT in patients with advanced ormetastatic pancreatic cancer. Ninety-four patients received chemotherapy. Among them,sixty-three were treated with GEM alone, twenty-two with UFT and GEM (UFT/GEM), andnine with S-1 and GEM ( S-1/GEM). The median survival time was 9 months with GEM, 7months with UFT/GEM, and 23 months with S-1/GEM. The overall response rate was 11percent, 10 percent, and 22 percent, respectively. The 1-year survival rate was 30 percent,36 percent, and 86 percent, respectively. Although the treatment-related adverse effectswere not infrequent in patients treated with S-1/GEM, they were moderate in intensity. Thecombination chemotherapy with S-1/GEM was well tolerated and yielded a high response