A review of clinical trials of chemotherapy for pancreatic cancer

摘要

Chemotherapy is playing an important role in treating pancreatic cancer, either when used alone or when combined with surgery and radiotherapy. We summarized 80 eligible clinical trials published from January in 2006 to June in 2011 and discussed the future development of chemotherapy in the treatment of pancreatic cancer. All the clinical trials were divided into 5 groups: single-agent regimen (14 trials), binary combination (27 trials), triple or more combination (13 trials), neoadjuvant/preoperative chemotherapy (4 trials), and targeted therapy (22 trials). Gemcitabine used alone was confirmed effective in 5 trials, while fixed-dose-rate gemcitabine showed apparent toxicities. In 4 trials, oral S-1 seemed feasible and convenient as a second-line agent. Explorations of irinotecan and paclitaxel loaded polymeric micelle as single agents also got positive outcomes. Many trials focused on the gemcitabine-based combinations with drugs like cisplatin, S-1, oxaliplatin, glufosfamide, etc., and some got positive results. Due to the occurrences of gemcitabine-resistance or even 5-fluorouracil-resistance, second-line combinations have become important and some have shown considerable value. Apart from the binary combination, three or more drugs used together, like FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) also exhibited promising activity. A new method called neoadjuvant therapy (treating patients with drugs before surgery) was investigated in 4 trials with encouraging outcomes. In addition, some sites related to tumor cell proliferation and metastasis, such as growth factor receptor, CTLA-4 (CD152), the mammalian target of rapamycin, cyclooxygenase-2, cholecystokinin-2 receptor, leukotriene B4 receptor, peroxisome proliferator-activated receptor gamma and proto-oncogene, have been explored in some clinical trials and are worth further researches.