Cancer of the pancreas: are we making progress? A review of studies in the US Oncology Research Network

BACKGROUND

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. In 2008, approximately 37,680 people will be diagnosed with pancreatic cancer and 34,290 will die of this disease.

METHODS

The authors reviewed the literature on treatment of pancreatic cancer with an emphasis on studies conducted in the US Oncology Research (USOR) Network.

RESULTS

Although much research has been conducted to develop improved systemic therapies of pancreatic cancer, gemcitabine as a single agent remains the current standard of care. Combinations with other chemotherapeutic drugs or biological agents have resulted in limited improvement.

CONCLUSIONS

Despite aggressive efforts to improve treatment for patients with pancreatic cancer, limited progress has been made. It is hoped that new studies being planned and conducted will improve outcomes for patients with this disease.

New treatment options for advanced pancreatic cancer

Pancreatic cancer has a very high mortality rate and affects approximately 230,000 individuals worldwide. Gemcitabine has become established as the standard therapy for advanced pancreatic cancer; however, the survival advantage is small. Adjuvant chemotherapy using either 5-fluorouracil or gemcitabine is now established in pancreatic cancer as an alternative therapy. Combinations of gemcitabine with either platin agents or capecitabine may be advantageous. Anti-EGFR and anti-VEGF agents have been unsuccessful but multiple tyrosine kinase inhibitors are under investigation. Of the increasing number of immunological agents, the GV1001 antitelomerase vaccine holds some interest. Targeted agents against important mitogenic pathways, including MEK/ERK, Src, PI3K/Akt, mTOR, Hedgehog and NF-kappaB, as well as agents targeting histone deacetylase, poly(ADP-ribose) polymerase, heat shock protein 90 and other agents such as beta-lapachone, hold considerable interest for further development. However, the probability of individual success is low.