Combination Chemotherapy Helpful in Some Patients With Unresectable Pancreatic Cancer

Laurie Barclay, MD

October 21, 2003

Oct. 21, 2003 — Combination chemotherapy is helpful in some patients with unresectable pancreatic cancer, according to a presentation at the American College of Surgeons annual meeting. Treatment with 5-fluorouracil, leucovorin, mitomycin C, and dipyridamole downstaged a small fraction of patients, allowing surgical resection.

"This is an isolated experience at a single institution," senior author Howard A. Reber, MD, a surgeon from the University of California in Los Angeles, told Medscape. "Before anybody jumps to the conclusion that it is a big breakthough, this needs to be duplicated in more centers with greater numbers of patients. The bright spot is that there are at least some patients who respond dramatically to this type of therapeutic treatment, and for these patients, it may be the light at the end of the tunnel."

Because pancreatic cancer is typically diagnosed at an advanced stage, only 10% to 15% of newly diagnosed patients are surgical candidates, and median survival without surgery is approximately eight months.

Of 12 patients with histologically proven, locally unresectable pancreatic cancer on initial exploration but with improvement on chemotherapy, five had standard resection and seven had the pylorus-preserving Whipple procedure. After combination chemotherapy, abdominal computed tomography showed a partial response in 10 patients and a complete response in two. In three patients, there was no histological evidence of malignancy and specimen margins were free of tumor. Two specimens showed lymph node metastases, five had perineural invasion, and two had microvascular invasion.

From the date of diagnosis, median survival was 35 months. Survival was 100% at one year, 82% at two years, 41% at three years, and 27% at five years. At follow-up, seven patients had died of recurrent disease, and five remained disease-free 10, 25, 48, 69, and 117 months after diagnosis.

"The intriguing theory is that if we could figure out why there are a few patients who react positively to this type of treatment and others who don't, that could be a major breakthrough in our understanding of how to tailor treatment to individual patients," Dr. Reber said.

This study received no financial support, and the authors report no financial conflicts of interest.

J Am Coll Surg. 2003;197:s73

Reviewed by Gary D. Vogin, MD

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