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| The most current treatment advice is found at
the NCCN guidelines
here. Read recent review articles on
testing, treatment for
advanced cases, treatment
after surgery and overall treatment
here.
Surgery is still the best treatment if the cancer is resectable. Most
patients are not candidates for surgery (see surgery
guidelines
and
resectability guidelines and more on surgical staging
here)
and may then be candidates for chemoradiation or chemotherapy alone (see flow chart,
read the radiation guidelines
and the chemotherapy guidelines, which have expanded the choice of chemotherapy drugs beyond 5FU to now include: Gemzar (gemcitabine), Platinol (cisplatin), Eloxatin (oxaliplatin) Zeloda (cepecitabine), Erbitux (cetuximab) and Avastin (bevacizumab, Tarceva (erlotinib). So far Gemzar alone may be the best drug and the combination with targeted drugs like Erbitux, Tarceva or Avastin have been somewhat disappointing. The best option may be to participate in a research trail (see the current NCI research trials here). In 2011 the ECOG trial showed better results with FOLFIRINOX over Gemzar (go here).
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Recent chemotherapy trials show better clinical response rates with drugs like Xeloda (capecitabine 24% response) or Gemzar (gemcitabine 23.8%) compared to more traditional 5-FU (4.8%) (J Clin On 2002;160.) Though the overall results with chemotherapy are not impressive (see ECOG trial of Gemzar plus 5FU and trial of Gemzar plus Platinol). The current RTOG trial (RTOG 0411) combines radiation with Xeloda and Avastin followed by Gemzar/Avastin. New data shows a value for combining Gemzar with Tarceva ( Tarceva / erlotinib, is the first drug in a Phase III trial to have shown a significant improvement in overall survival when added to gemcitabine chemotherapy in first-line pancreatic cancer,) |
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