Despite advances in our understanding of the molecular and genetic basis of
pancreatic cancer, the outcome for this disease remains dismal.
Gemcitabine, the standard
chemotherapy for
pancreatic cancer, offers modest improvement of
tumor-related symptoms and marginal advantage of survival. Many chemotherapeutic and targeted agents have been pitted against or combined with
gemcitabine in randomized phase III trials and no
drug was shown to be superior to single-agent
gemcitabine except two
gemcitabine-containing combinations:
capecitabine plus
gemcitabine vs.
gemcitabine and
erlotinib. In this article, the author debates: "Is there a standard of care for the treatment of advanced
pancreatic cancer?". In addition, he summarizes the key studies presented at the "
Gastrointestinal Cancers Symposium" held in Orlando, FL, USA on January 25-27, 2008. The studies discussed here include the following: i) a phase I study of a
chemotherapy doublet
gemcitabine plus
capecitabine, combined with a
biologic doublet (
bevacizumab plus
erlotinib) in patients with advanced pancreatic
adenocarcinoma (abstract #141); ii) a phase II study of
gemcitabine,
bevacizumab, and
erlotinib in locally advanced and metastatic
adenocarcinoma of the pancreas (abstract #151); iii) final results of the multicenter phase II study on
gemcitabine,
capecitabine, and
bevacizumab in patients with advanced
pancreatic cancer (abstract #198); iv) interim results from a phase II study of
volociximab in combination with
gemcitabine in patients with metastatic
pancreatic cancer (abstract #142); v) a pilot study of
combination chemotherapy with S-1 and
irinotecan for advanced
pancreatic cancer (abstract #155); vi) a multicenter phase II study of
gemcitabine and
S-1 combination chemotherapy in patients with unresectable
pancreatic cancer (abstract #212); vii) a phase I/II study of
PHY906 plus
capecitabine in patients with advanced
pancreatic carcinoma (abstract #260); and viii) the final results of a phase II trial of
Genexol-PM(R), a novel
cremophor-free, polymeric
micelle formulation of
paclitaxel in patients with advanced
pancreatic cancer (abstract #269). Based on the results presented at the meeting, it comes to us that patients with locally advanced vs. metastatic
pancreatic cancer should be studied separately, better understanding of the biology of
pancreatic cancer is mandatory and evaluation of novel agents is crucial. We, as oncologist, have to change our attitudes towards clinical trials and need to think beyond a trial design such as
gemcitabine vs.
drug of our choice.