Current Status of Non-surgical Treatment for Pancreatic Cancer in Japan
- VernacularTitle:Нойр булчирхайн өмөнгийн мэс заслын бус эмчилгээнийЯпон дахь өнөөгийн байдал
- Author:
Tatsuya Ioka
- Publication Type:journal article
- From:Innovation
2014;8(4):108-109
- CountryMongolia
- Language:English
-
Abstract:
In Japan, pancreatic cancer (PC) represents the fourth leading cause of death
resulting from cancer in females and the fifth leading cause of death in males
since 2009. The incidents of death from PC are increasing rapidly.
Chemotherapy appears to prolong survival in patients with advanced PC, and it
can give clinical benefits and improve quality of life since the first clinical use of
gemcitabine (Gem) in Japan in 1999.1)
Many investigators have struggled to prove the superiority of Gem-contained
combination therapy over Gem monotherapy for PC patients. Unfortunately,
they all failed to prove the better survival benefit except with Gem plus Erlotinib
(GE)2). GE therapy demonstrates to be superior both in metastatic and locally
advanced PC (HR 0.81: 0.67-0.97). Many patients with GE therapy suffer from
skin rash, and sometimes are afraid of the risk of interstitial lung diseases (ILD).
Gem plus S1 (GS) showed both good survival benefits and anti-tumor effects in
previous phase II studies. We conducted a phase III study called GEST trial in
Japan and in Taiwan, which aimed to make sure of the superiority of GS to Gem
and the non-inferiority of S1 to Gem. However, we can only prove the noninferiority
of S1 to Gem in OS, both in metastatic and locally advanced PC (HR
0.96: 0.78-1.18) 3).
In 2013, Gem plus nab-paclitaxel was shown to improve survival compared to
gemcitabine alone with MPACT trial, (HR 0.72: 0.62-0.83)4), while it shows
moderate hematological toxicities and peripheral neuropathy.
French investigators created a new standard chemotherapy which doesn’t contain
Gem: FOLFIRINOX. A FOLFIRINOX regimen can deliver a much better survival
benefit rather than Gem monotherapy in metastatic PC (HR 0.57: 0.45-0.73)5).
However, FOLFIRINOX increases both hematological and non-hematological
adverse effects (AE).
It is not clear whether radiotherapy should be useful or beneficial for locally
advanced PC. Moreover, we don’t have a satisfying answer which drug we should
administer when we plan the chemo radiotherapy for PC. Currently, there are
some randomized phase II studies of chemo radiotherapy for PC in Japan. One is
a study of chemo radiotherapy using GS combination compared with GS therapy,
and the other is a study of Gem monotherapy followed by S1-chemoradiothrapy
compared with S1-chemoradiotherapy. We need a well-designed phase II or
phase III trial to prove the benefit of radiotherapy for PC in the future. But it is
difficult to standardize a procedure of radiotherapy in many institutions, even in
Japan.
We need to develop more chemotherapy or chemo radiotherapy options for PC,
because we don’t have enough anti-cancer agents to administer. There are still
many clinical questions to solve.
