tailieunhanh - Chapter 089. Pancreatic Cancer (Part 4)

Pancreatic Cancer: Treatment Symptoms and the associated impaired performance status are significant issues in the management of patients with pancreatic cancer, as they can have a marked negative impact on the ability to safely deliver chemotherapy or perform curative surgery. For example, patients with malabsorption secondary to pancreatic insufficiency may be treated with pancreatic enzyme supplementation. Indeed effective symptom management is as important a therapeutic goal as survival prolongation. Advanced Pancreatic Cancer These patients have metastatic or locally advanced inoperable disease and are the majority with newly diagnosed disease. . | Chapter 089. Pancreatic Cancer Part 4 Pancreatic Cancer Treatment Symptoms and the associated impaired performance status are significant issues in the management of patients with pancreatic cancer as they can have a marked negative impact on the ability to safely deliver chemotherapy or perform curative surgery. For example patients with malabsorption secondary to pancreatic insufficiency may be treated with pancreatic enzyme supplementation. Indeed effective symptom management is as important a therapeutic goal as survival prolongation. Advanced Pancreatic Cancer These patients have metastatic or locally advanced inoperable disease and are the majority with newly diagnosed disease. Debulking surgery or partial resections have no role as these procedures are associated with the same risks as a curative resection but are unlikely to improve survival. Many patients may however benefit from endoscopic biliary or duodenal stenting and some patients from nerve plexus blocks or ablation. Less frequently intestinal bypass surgery is required. The deoxycytidine analogue gemcitabine given as a single agent gemcitabine 1000 mg m2 weekly for 7 weeks followed by 1 week rest then weekly for 3 weeks every 4 weeks thereafter has been the preferred treatment for these patients since it was shown to yield clinical benefit a composite parameter for evaluating symptomatic benefit of treatment used in some trials of this disease and improved survival compared to 5-fluorouracil. The median survival observed with single-agent gemcitabine in randomized trials is about 6 months with a 12month survival of approximately 18 . Furthermore two randomized trials have shown improved survival from the addition of either the oral fluoropyrimidine capecitabine gemcitabine 1000 mg m2 days 1 8 and 15 plus capecitabine 1660 mg m2 days 1-21 repeated every 28 days or the tyrosine kinase inhibitor of the epidermal growth factor receptor EGFR erlotinib standard gemcitabine plus erlotinib 100 mg daily . .