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 deathresulting from cancer in females and the fifth leading cause of death in malessince 2009. The incidents of death from PC are increasing rapidly.Chemotherapy appears to prolong survival in patients with advanced PC, and itcan give clinical benefits and improve quality of life since the first clinical use ofgemcitabine (Gem) in Japan in 1999.1)Many investigators have struggled to prove the superiority of Gem-containedcombination 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 locallyadvanced PC (HR 0.81: 0.67-0.97). Many patients with GE therapy suffer fromskin 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 inprevious phase II studies. We conducted a phase III study called GEST trial inJapan and in Taiwan, which aimed to make sure of the superiority of GS to Gemand the non-inferiority of S1 to Gem. However, we can only prove the noninferiorityof S1 to Gem in OS, both in metastatic and locally advanced PC (HR0.96: 0.78-1.18) 3).In 2013, Gem plus nab-paclitaxel was shown to improve survival compared togemcitabine alone with MPACT trial, (HR 0.72: 0.62-0.83)4), while it showsmoderate hematological toxicities and peripheral neuropathy.French investigators created a new standard chemotherapy which doesn’t containGem: FOLFIRINOX. A FOLFIRINOX regimen can deliver a much better survivalbenefit rather than Gem monotherapy in metastatic PC (HR 0.57: 0.45-0.73)5).However, FOLFIRINOX increases both hematological and non-hematologicaladverse effects (AE).It is not clear whether radiotherapy should be useful or beneficial for locallyadvanced PC. Moreover, we don’t have a satisfying answer which drug we shouldadminister when we plan the chemo radiotherapy for PC. Currently, there aresome randomized phase II studies of chemo radiotherapy for PC in Japan. One isa study of chemo radiotherapy using GS combination compared with GS therapy,and the other is a study of Gem monotherapy followed by S1-chemoradiothrapycompared with S1-chemoradiotherapy. We need a well-designed phase II orphase III trial to prove the benefit of radiotherapy for PC in the future. But it isdifficult to standardize a procedure of radiotherapy in many institutions, even inJapan.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 stillmany clinical questions to solve.
