Pancreatic Cancer

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

CHARLESTON, South Carolina-‘‘Highly censored data” from a multicenter phase II trial of irinotecan (Camptosar)/gemcitabine (Gemzar) suggest that this combination, known as IrinoGem, “is well tolerated and active in advanced and metastatic pancreatic cancer,” Caio Max S. Rocha Lima, MD, reported at a clinical investigators’ workshop. IrinoGem is now being compared to gemcitabine alone in an international multicenter phase III randomized trial involving 75 institutions and 350 patients with locally advanced or metastatic pancreatic adenocarcinoma.

NEW ORLEANS-Treatments combining irinotecan (Camptosar) with other drugs are active and well-tolerated in patients with advanced and metastatic pancreatic and ovarian cancer, according to two reports presented at the 36th annual meeting of the American Society of Clinical Oncology.

ORLANDO-A number of therapies now in clinical trials may make a difference in outcome for patients with pancreatic cancer, and some may indefinitely prolong survival, Alexander S. Rosemurgy II, MD, said at the Joint Cancer Conference of the Florida Universities. The conference is sponsored by the Univerity of South Florida College of Medicine and presented by the H. Lee Moffitt Cancer Center & Research Institute, University of Florida Shands Cancer Center, and University of Miami Sylvester Comprehensive Cancer Center..

NEW YORK-Gemcitabine (Gem-zar), approved for the treatment of advanced pancreatic cancer, may have value as a modulator of standard chemotherapy in advanced colorectal cancer, Stefan Madajewicz, MD, said at the Chemotherapy Foundation Symposium XVII. Dr. Madajewicz, professor of medicine and chief of neoplastic diseases, Division of Medical Oncology, SUNY Health Center, Stony Brook, NY, reported on phase I/II trials of gemcitabine in colorectal cancer used in combination with fluorouracil (5-FU) and folinic acid.

NEW YORK-Although it is often not possible to offer curative treatment in pancreatic cancer, significant improvements have taken place nonetheless, said Ephraim S. Casper, MD, chief medical oncologist, Memorial Sloan-Kettering Cancer Center at St. Clare’s Hospital, Denville, NJ.

NEW YORK-A regimen of twice-weekly gemcitabine (Gemzar) plus radiation therapy in patients with unresectable pancreatic cancer appears promising, according to results of a phase I dose escalation study presented at the Chemotherapy Foundation Symposium XVII. The twice-weekly delivery may be more cytotoxic than standard once-weekly dosing, and gemcitabine may act as a radiation sensitizer, said A. William Blackstock, MD, assistant professor of Radiation Oncology, Wake Forest University, Winston-Salem, NC.

Both gastric and pancreatic cancer remain leading causes of cancer death in the United States and worldwide. While surgical resection continues to be required for long-term cure of both these neoplasms, 5-year survival

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The patients will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia, is the principal investigator.

An innovative clinical trial to be conducted at ColumbiaUniversity in New York City for people diagnosed with advanced pancreatic cancer is now recruiting patients. The volunteer patients will test the effectiveness of what is called “the Gonzalez

PHILADELPHIA-Results of a phase I/II study showed that Virulizin, an investigational monocyte and macrophage activator, has clinical activity in treating advanced pancreatic cancer comparable to that of gemcitabine (Gemzar) and with a “much better” safety profile, Changnian Liu, MD, PhD, of the University of Nebraska Medical Center, reported at the annual meeting of the American Association for Cancer Research.

ORLANDO-The delivery of neurolytic chemicals to the celiac plexus, guided by endoscopic ultrasound, has been shown to be an effective, convenient, and safe technique to provide pain relief for pancreatic cancer patients.

An innovative clinical trial to be conducted at Columbia University in New York City forpeople diagnosed with advanced pancreatic cancer is now recruiting patients. The volunteer patients will test the effectiveness of what is called “the Gonzalez

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The patients will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia, is the principal investigator.

NEW YORK-An innovative clinical trial to be conducted at Columbia University is now recruiting patients with advanced pancreatic cancer. The study will test the effectiveness of the “Gonzalez regimen,” which combines a strict diet of fresh fruits, vegetable juices, dietary supplements, and pancreatic enzyme extracts with a “detoxification” program. John Chabot, MD, a surgical oncologist at Columbia-Presbyterian Cancer Center, is the principal investigator.

A phase I, single-center, open-label, dose-escalation study (University of Alabama [UAB] 9614) has been undertaken to evaluate the feasibility and safety of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus oral

Michael H. Levy, MD: This 38-year-old white male first came to his physician in January of 1993 complaining of epigastric and low back pain. In March of 1993, he was diagnosed with pancreatic cancer that was metastatic to his

WASHINGTON-Cancer patients are better off seeking treatment at high-volume institutions when they require complicated cancer surgery or chemotherapy, according to a new report from the National Cancer Policy Board (NCPB). It listed pancreatic cancer surgery, removal of all or part of the esophagus, and removal of pelvic organs as examples of such procedures.

The January issue of Science reported that researchers had successfully extended the lifespan of normal human cells using the enzyme telomerase to lengthen telomeres. Reaction to these initial findings was guarded. Oncologists were concerned that the

INDIANAPOLIS--Eli Lilly and Company’s Gemzar (gemcitabine) has received FDA approval for use as first-line treatment of inoperable, locally advanced, or metastatic non-small-cell lung cancer (NSCLC) in combination with cisplatin (Platinol). The agent was previously approved as first-line, single-agent therapy of locally advanced or metastatic pancreatic cancer

Eniluracil is a potent inactivator of dihydropyrimidine dehydrogenase (DPD), which is the first enzyme in the degradative pathway of systemically administered 5-fluorouracil (5-FU). Two completely oral regimens of eniluracil plus 5-FU are being evaluated in clinical trials: (1) a chronic schedule with both agents administered BID in a 10:1 ratio for 28 days of a 5-week course, and (2) a 5-day schedule of eniluracil once daily on days 1 through 7 and 5-FU once daily on days 2 through 6. The clinical development of eniluracil is being pursued in several tumor types, including colorectal cancer, breast cancer, and pancreatic cancer. Response rates achieved in a phase II study of the chronic schedule of oral eniluracil/5-FU in patients with colorectal cancer compare favorably with those obtained in trials of intravenous 5-FU and leucovorin, while results from other trials are awaited. Safety analysis for the 28-day schedule has revealed a low incidence of severe toxicities, particularly as compared with standard 5-FU regimens. [ONCOLOGY 12(Suppl 7):52-56, 1998]

LOS ANGELES--A second-generation topo-isomerase I inhibitor, RFS 2000, has led to significantly improved survival in patients with advanced pancreatic carcinoma, according to interim results of an ongoing phase II study presented at an ASCO poster session.

HAMBURG-The challenge in the treatment of pancreatic cancer “is to take systemic therapy one step further, whether it’s with new drugs or with novel approaches based on new biologic information,” Margaret Tempero, MD, of the University of Nebraska Medical Center, Omaha, said at the Ninth European Cancer Conference (ECCO 9), sponsored by the Federation of European Cancer Societies.

For decades, pancreatic cancer has been one of the most difficult and frustrating cancers to treat. Despite the promising response rates achieved with a number of chemotherapeutic regimens evaluated in phase II trials in the 1970s and ’80s, no regimen proved superior to single-agent fluorouracil (5-FU) in terms of overall survival. As a result, some oncologists adopted a position of therapeutic nihilism and criticized what appeared to be futile attempts to identify effective therapy for patients with advanced-stage disease. Instead, they argued that clinical research efforts should focus on the development of adjuvant therapy for patients with earlier-stage disease.[1]

Michael and Moore provide an excellent review of the frustrating history of drug development for pancreatic cancer. These frustrations have been accompanied by the knowledge that pancreatic adenocarcinoma has almost always metastasized systemically, most often to the liver, by the time the patient comes to a physician.[1] Thus, local treatment, while important, will ultimately cure only a few patients in the absence of effective concomitant or sequential systemic therapy.

The treatment of advanced pancreatic carcinoma has been viewed with pessimism. Because of the lack of activity of commonly used agents, there is no consensus regarding a standard chemotherapy regimen. Assessment of

UFT (tegafur and uracil) has been studied extensively in Japan, with documented efficacy in hepatobiliary and pancreatic cancer. In the United States, UFT with or without leucovorin has not undergone phase II testing in

Although candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute, professor of medicine, and chairman of the Department of Preventive Medicine and Public Health, Creighton University School of Medicine, and director of the Creighton Cancer Center, Omaha, Nebraska. Part I of this three-part series on pancreatic cancer appeared in June 1997. Part II (below) reviews the gene mutations thought to contribute to the development of hereditary pancreatic cancer, and Part III will explores the clinical recognition of a hereditary predisposition to pancreatic cancer.