Pancreatic Cancer

Cancer of the pancreas is the fourth leading cause of cancer death in the United States. Of the 28,000 patients diagnosed each year, more than 95% will die of pancreatic cancer. Therefore, the focus of therapy for most patients is palliative care. In fact, the most active single-agent therapy for advanced disease-gemcitabine (Gemzar)-was first compared to fluorouracil (5-FU) with relief of disease symptoms as a primary end point. However, the survival with gemcitabine remains approximately 6 months for advanced disease, and no new agent, either alone or in combination, has exceeded this time frame in phase III study.

Gastroenteropancreatic tumors, although relatively rare, present management problems that may last many years, in comparison with the usually more aggressive adenocarcinomas whose management may encompass a far briefer span of time. In general, 50% of such tumors are insulinomas, while gastrinomas comprise 25%, and nonfunctional tumors 20% VIPomas and glucagonomas are the predominant lesions of the remaining 5%. Clinical diagnosis is usually made on the presence of the classical symptom complex. In uncertain circumstances or covert presentations, the critical diagnostic biochemical test is plasma chromogranin A as well as measurement of the specific peptide.

A 48-year-old man is referred for evaluation. He has a history of hypercholesterolemia and obesity. Treatment with cholesterol-lowering medication was associated with elevated liver chemistries. When the elevated liver chemistries persisted

Fujirebio Diagnostics recently announced that its CA 19-9 radioimmunoassay for monitoring of pancreatic cancer patients received marketing clearance from the US Food and Drug Administration (FDA). The CA 19-9 radioimmunoassay is the first

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Adenocarcinoma of the pancreas remains a lethal malignancy: The majority of patients with pancreatic cancer continue to present with advanced disease and die within a year of diagnosis. Despite this grim fact, some progress has been made over the past decade, particularly in the surgical management of patients with resectable and advanced disease. This well-constructed review by Drs. Ahrendt and Pitt succinctly details the advances that have been made and highlights many of the unresolved issues.

It is with great pleasure that I comment on the excellent article authored by Drs. Ahrendt and Pitt, who have provided a well-written, succinct, up-to-date review focusing on adenocarcinoma of the pancreas. The authors introduce the topic, discuss preoperative staging and assessment of resectability, cover the critical issues regarding resectional therapy and palliative surgery, and provide data on the results of such therapy, including mortality, morbidity, and quality-of-life outcomes. Emphasizing the importance of this topic, the authors note that pancreatic cancer is the fifth leading cause of cancer death in the United States.

Pancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Early clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.

The combination of irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) produced a 1-year survival rate of 27%, which is greater than that reported for gemcitabine alone in previous studies in patients with advanced pancreatic cancer (15% and 18% 1-year survival rates, respectively). These study results were published in a recent issue of the Journal of Clinical Oncology (20:1182-1191, 2002).

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.

Lorus Therapeutics announced recently that it has initiated a phase III trial to evaluate the macrophage activator Virulizin for the treatment of advanced pancreatic cancer. The company will present the results of this trial to the US Food and Drug Administration (FDA) in a new drug application at the completion of the study.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

The article by Drs. Levy and Wiersema is an excellent overview of the indications, technical nuances, and efficacy of endoscopic ultrasound in the diagnosis and staging of pancreatic neoplasms. Endoscopic ultrasonography was introduced into the diagnostic armamentarium for gastroenterology approximately 15 years ago. Although the literature suggests a general increase in the utility and experience with endoscopic ultrasound, the technique remains most effective in the hands of experienced experts like Drs. Levy and Wiersema. Their article is a complete and thorough review of the indications and expected accuracy of the technique when evaluating a variety of different pancreatic lesions.

Two decades have elapsed since publication of the first papers describing the examination of the pancreas via the stomach and the duodenum using an ultrasound probe fixed to an endoscope tip. Initial attempts to image the pancreas in this fashion proved difficult and frustrating, but they were promising enough that instrument makers and gastrointestinal endoscopists persisted in developing increasingly effective devices.

Patients with signs and symptoms suggestive of a pancreatic neoplasm typically undergo initial imaging with transabdominal ultrasound or computed tomography. This evaluation often reveals the presence of a pancreatic mass or fullness.

Drs. Levy and Wiersema have provided an authoritative review of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. As outlined in their article, endoscopic ultrasound has emerged as an important tool in the diagnostic evaluation of many patients with suspected pancreatic neoplasms. We concur that endoscopic ultrasound is part of the standard preoperative evaluation of patients with biochemically confirmed insulinoma and gastrinoma syndromes and of at-risk patients with multiple endocrine neoplasia type 1. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration (FNA) can also accurately determine the etiology of a cystic pancreatic neoplasm by differentiating between mucinous, serous, and inflammatory (pseudocyst) lesions.

SAN FRANCISCO-Two phase II chemotherapy regimens combining gemcitabine (Gemzar) and docetaxel (Taxotere) in patients with advanced pancreatic cancer show higher response rates than gemcitabine alone and suggest further explorations of the combination are warranted, according to presentations at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO).

SAN FRANCISCO-In patients with advanced pancreatic cancer, the combination of gemcitabine (Gemzar) followed by oxaliplatin (investigational in the United States) (GEMOX) is active with low toxicity, Christophe Louvet, MD, Hôpital St-Antoine, Paris, France, said at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 506).

SAN FRANCISCO-Two studies presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO) show no advantage to adding fluorouracil (5-FU) to gemcitabine (Gemzar) in patients with advanced pancreatic cancer.

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single