review of literature on clinical pancreatology - The Pancreapedia

flavopiridol and docetaxel has minimal activity and significant toxicity in this patientpopulation. These results reflect the challenges <strong>of</strong> treating patients with pancreatic cancer ina second-line setting where the risk/benefit equation is tightly balanced [549].S-1The prognosis for advanced pancreatic cancer with peritoneal dissemination is extremelypoor, and no effective standard therapy has been established. It was presented a case <strong>of</strong> avery old patient whose quality <strong>of</strong> life improved shortly after administration <strong>of</strong> only S-1 to treatadvanced pancreatic cancer with peritoneal dissemination. Considering his general conditiondue to old age, the regimen for oral S-1 (80 mg/body/day) was set at 4 consecutive weeks <strong>of</strong>administration followed by a 2-week rest period. His abdominal circumference decreased andhis appetite improved by 14 days following commencement <strong>of</strong> the therapy. The bloodexamination one month following commencement showed a significant decrease in the tumormarker. There was no adverse drug reaction. Six months later CT scanning showed that theascites had disappeared and that the low-density area at the tail <strong>of</strong> the pancreas hadbecome less obvious. The tumor marker and biochemical parameters were within standardranges. Twelve months since the therapy began: there still has been no adverse drugreaction and his quality <strong>of</strong> life has been good [550].EGFR-inhibitorIt was evaluated the epidermal growth factor receptor (EGFR) inhibitor gefitinib anddocetaxel in a phase II study following gemcitabine failure. EGFR overexpression was notrequired. The initial docetaxel dose was 75 mg/m 2 on day 1 every 21 days. Due to febrileneutropenia in 8 <strong>of</strong> the first 18 patients, the dose was reduced to 60 mg/m 2 . Gefitinib, 250mg/day orally, was given continuously. Forty-one patients received treatment and wereevaluable. Febrile neutropenia was seen in 11 patients (27 %), with most events occurring atthe docetaxel dose <strong>of</strong> 75 mg/m 2 (8 <strong>of</strong> 18 patients). Common treatment-related grade 3/4toxicities were: fatigue (7 %), nausea (7 %), diarrhea (5 %) and vomiting (2 %). There was 1partial response and stable disease in 19 patients. Time to progression was 2 months andmedian survival was 5 months (95 % confidence interval 2.9-5.7). This means that thecombination <strong>of</strong> gefitinib and docetaxel showed evidence <strong>of</strong> limited efficacy [551].Radiotherapy with 5-FU, Gemcitabine or S-1In one study, it was examined the safety and efficacy <strong>of</strong> chemoradiation in cases with localrecurrence <strong>of</strong> pancreatic or biliary cancer after primary resection. Seven consecutive patientswith recurrence <strong>of</strong> carcinoma <strong>of</strong> pancreas (n=3) and biliary system (n =4) were treatedchemoradiotherapy. Local recurrence occurred around the portal vein in 6 patients andremnant pancreas in one patient respectively. Disease free survival after primary surgerywas 22 months (range: 5-84). All patients received 50 Gy <strong>of</strong> conformal three-dimensionalradiotherapy with concurrent 5-FU, Gemcitabine or S-1. Grade 3 <strong>of</strong> anorexia and elevation <strong>of</strong>transaminase level occurred in one patient respectively. Local tumor response was observedin two patients <strong>of</strong> pancreatic and biliary cancer respectively. Median survival calculated fromthe start <strong>of</strong> the chemoradiotherapy was 15 months (range: 6-24) in pancreatic cancer and 14months (range: 11-20)in biliary cancer. The data suggest that chemoradiotherapy is feasibleand effective treatment option in patients who present local recurrence after primary surgeryin pancreatic or biliary cancer [552].ImmunotherapyDendritic cell (DC) therapy frequently induces a measurable immune response. Howeverclinical responses are seen in a minority <strong>of</strong> patients, presumably due to insufficientexpansion <strong>of</strong> antigen-specific cytotoxic T lymphocytes (CTLs) capable <strong>of</strong> eradicating tumorcells. To increase therapeutic efficacy <strong>of</strong> DC-based vaccination, we have undertaken the firstclinical trial involving a combination therapy <strong>of</strong> gemcitabine (GEM) with immunotherapy forpatients with inoperable locally advanced pancreatic cancer. Five patients received thetreatment course, which consisted <strong>of</strong> intravenous GEM administration at 1000 mg/m 2 (day 1)