Consensus on the treatment of pancreatic cancer in Spain View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-05-27

AUTHORS

Manuel Hidalgo, Albert Abad, Enrique Aranda, Luis Díez, Jaime Feliu, Carlos Gómez, Antonio Irigoyen, Rafael López, Fernando Rivera, Carmen Rubio, Javier Sastre, Josep Tabernero, Eduardo Díaz-Rubio

ABSTRACT

Pancreatic cancer (PC) represents one of the greatest oncological challenges of our century, due to its high mortality and incidence. A group of Spanish experts in PC treatment reviewed data available on different therapeutic combinations and established consensus on what would be the best strategy in PC management, depending on the stage of the disease. Surgery with complete resection may produce 5-year survival rates of 18–24%, but definitive control is still precarious. In the absence of consensus, the best evidence suggests that adjuvant chemotherapy with gemcitabine for 6 months using the CONKO-001 regime is the treatment of choice after resection of PC for patients with acceptable functional status. This group recommends chemoradiotherapy (CT-RT) in patients with factors for poor loco-regional prognosis. However, chemotherapy is an option for the treatment of locally advanced PC in patients with good general status and in the absence of metastatic disease the recommended treatment is CT-RT followed by gemcitabine-based chemotherapy. A period of chemotherapy followed by consolidation CT-RT may be appropriate, as it allows selection of patients with locally advanced disease who may benefit most from combined treatment. Erlotinib combined with gemcitabine shows significant survival improvement in PC and must be considered an option in the first-line treatment of advanced and metastatic PC. The gemcitabine-erlotinib combination is proposed as the standard treatment for metastatic PC in patients with PS≥2. In patients with PS<2, gemcitabine-erlotinib is recommended as the first-line treatment option, supported by a maximum degree of evidence, without ruling out other options, such as gemcitabine-oxaliplatin, gemcitabine-capecitabine or gemcitabine alone. More... »

PAGES

290-301

References to SciGraph publications

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  • 2008-03-28. Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer in BMC CANCER
  • 2008-06-13. PET/CT Fusion Scan Enhances CT Staging in Patients with Pancreatic Neoplasms in ANNALS OF SURGICAL ONCOLOGY
  • 2006-09-06. Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival in ANNALS OF SURGICAL ONCOLOGY
  • 2007-07-10. High expression of RelA/p65 is associated with activation of nuclear factor-κB-dependent signaling in pancreatic cancer and marks a patient population with poor prognosis in BRITISH JOURNAL OF CANCER
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  • 1992-02. Human/mouse chimeric antibodies show low reactivity with human anti-murine antibodies (HAMA) in BRITISH JOURNAL OF CANCER
  • 2005-03-23. Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by Computed Tomography in SURGICAL ENDOSCOPY
  • 2001-03. Neoadjuvant Chemoradiotherapy for Adenocarcinoma of the Pancreas: Treatment Variables and Survival Duration in ANNALS OF SURGICAL ONCOLOGY
  • 2007-10. Meta-Analysis of Randomised Trials Comparing Gemcitabine-Based Doublets versus Gemcitabine Alone in Patients with Advanced and Metastatic Pancreatic Cancer in DRUGS & AGING
  • 2007-03-06. Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO) in BMC CANCER
  • 2006-07-24. Borderline Resectable Pancreatic Cancer: Definitions, Management, and Role of Preoperative Therapy in ANNALS OF SURGICAL ONCOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s12094-009-0357-3

    DOI

    http://dx.doi.org/10.1007/s12094-009-0357-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1019059205

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19451062


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    26 schema:description Pancreatic cancer (PC) represents one of the greatest oncological challenges of our century, due to its high mortality and incidence. A group of Spanish experts in PC treatment reviewed data available on different therapeutic combinations and established consensus on what would be the best strategy in PC management, depending on the stage of the disease. Surgery with complete resection may produce 5-year survival rates of 18–24%, but definitive control is still precarious. In the absence of consensus, the best evidence suggests that adjuvant chemotherapy with gemcitabine for 6 months using the CONKO-001 regime is the treatment of choice after resection of PC for patients with acceptable functional status. This group recommends chemoradiotherapy (CT-RT) in patients with factors for poor loco-regional prognosis. However, chemotherapy is an option for the treatment of locally advanced PC in patients with good general status and in the absence of metastatic disease the recommended treatment is CT-RT followed by gemcitabine-based chemotherapy. A period of chemotherapy followed by consolidation CT-RT may be appropriate, as it allows selection of patients with locally advanced disease who may benefit most from combined treatment. Erlotinib combined with gemcitabine shows significant survival improvement in PC and must be considered an option in the first-line treatment of advanced and metastatic PC. The gemcitabine-erlotinib combination is proposed as the standard treatment for metastatic PC in patients with PS≥2. In patients with PS<2, gemcitabine-erlotinib is recommended as the first-line treatment option, supported by a maximum degree of evidence, without ruling out other options, such as gemcitabine-oxaliplatin, gemcitabine-capecitabine or gemcitabine alone.
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