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Gastrointestinal Cancer

Metastatic Pancreatic Cancer 2008: Is the Glass Less Empty?

^aContinuum Cancer Centers of New York, Beth Israel Medical Center, New York, New York, USA; ^bContinuum Cancer Centers of New York, St. Luke's-Roosevelt Hospital, New York, New York, USA

Key Words. Metastatic pancreatic cancer • Gemcitabine • Oxaliplatin • Pancreatic enzyme replacement therapy • Erlotinib

Correspondence: Peter Kozuch, M.D., 10 Union Square East, Suite 4C, New York, New York 10003, USA. Telephone: 212-844-8070; Fax: 212-844-2027; e-mail: PKozuch{at}chpnet.org

Received September 27, 2007; accepted for publication March 3, 2008.

Disclosure: No potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Pancreatic cancer is the fourth most common cause of adult cancer death in the U.S. The high mortality rate from pancreatic cancer is a result of the high incidence of metastatic disease at the time of diagnosis, an often fulminant clinical course, and the lack of adequate systemic therapies. Unfortunately, only 5%–25% of patients present with tumors amenable to resection. The median disease-free survival interval following resection for operable pancreatic cancer is 13.4 months for patients treated with adjuvant gemcitabine and 6.9 months for untreated patients. A much higher percentage of patients present with metastatic disease (40%–45%) or locally advanced disease (40%), and have median survival times of 3–6 months or 8–12 months, respectively. The frustrating lack of significant clinical advancements in the treatment of metastatic pancreatic cancer remains one of medical oncology's biggest disappointments. The past decade-long frustration has resulted in regulators, investigators, and practicing oncologists gradually lowering their standards/expectations with regard to interpreting clinical trials. Two of the more important examples of this include the approval of gemcitabine plus erlotinib and the use of a progression-free survival advantage to defend the use of gemcitabine plus oxaliplatin. Given the marginal benefit of systemic antineoplastics, a scholarly review inclusive of other palliative strategies will help oncologists optimize the care of pancreatic cancer patients. This article examines the existing evidence in support of a role for palliative therapy in metastatic pancreatic cancer, describes recent developments with newer chemotherapeutic and molecular-targeted agents, and explores future study designs.

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