Reflections on treatment strategies for palliative chemotherapy of pancreatic cancer.

Following our concept of efficacy-orientated sequential polychemotherapy, we report on the results of palliative chemotherapy in 69 patients suffering from exocrine pancreatic cancer, admitted to our unit in 2004. Evaluation of tumor response was mainly based on the serum courses of the tumor markers CA 19-9 and CEA; in addition, the modern imaging methods CT or MRT, including MRCP and MR-angiography, were performed bi-monthly. The median survival of the 69 patients (65% metastasized stages) was 16 months. The median survival increased with the number of effective treatment sequences, for the whole group from 5 to 10 and 23 months in relation to 0, 1 and > 1 effective sequences respectively. The results support our concept of EOSPC in pancreatic cancer patients, compared to clinical studies following protocols with only 1 treatment sequence and median survival rates of no more than 6-9 months. Compared to the efficacy-orientated sequential polychemotherapy (EOSPC) concept, which does not exclude but also allows the inclusion of clinical trials for further evaluation of new drugs or drug combinations, the common practice looking for survival in studies following protocols with only 1 treatment sequence might represent a negative predictive factor with respect to overall survival, as can be demonstrated by a comparison of our data with relevant recent literature. Our results further indicate that the interest of the clinicians and companies should not be focused only on first-line therapies, but also on 2nd- and 3rd-line strategies, as in our patients a second- and third-line therapy could be started in 73% and 68% of the patients respectively.

Further evidence for prolongation of survival of pancreatic cancer patients by efficacy orientated sequential polychemotherapy (EOSPC) based on serial tumor marker determinations (CA 19-9/CEA).

The results of palliative chemotherapy in 55 patients suffering from exocrine pancreatic cancer are reported, following our concept of efficacy orientated sequential polychemotherapy (EOSPC). Tumor answer/regression was mainly analyzed on the basis of the serum courses of the tumor markers CA 19-9 and CEA. Up to four different treatment trials were tried in the individual patients. The results confirm previously published data: a prolongation of survival in relation to the number of effective treatments (CR/PR/MR/SD vs. PD). The median survival of the whole group of patients (n=55, including n=39 patients with distant metastasis) was 12 months. The results support our concept of EOSPC in pancreatic cancer patients in order to improve survival. Furthermore, the data should stimulate attention not only on new and potentially more effective 1st- line regimens, but also to effective 2nd- and/or 3rd-line treatments. Moreover, the results should encourage clinicians to rediscuss the actual concepts of prospective therapeutical trails mainly based on analyzing the effects of single agents or drug combinations on survival. Furthermore, a comparison of 1st-line treatments with gemcitabine as monotherapy, and in combination with mitomycin-C, confirms that the combination of gemcitabine + mitomycin-C seems to be more active than gemcitabine monotherapy and that this combination might also be of value as 2nd-line therapy after gemcitabine monotherapy.