Chemotherapy for patients with unresesctable pancreatic cancer is recommended in the Clinical Practice Guidelines for Pancreatic Cancer 2019

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  • FURUSE Junji
    Department of Medical Oncology, Kyorin University Faculty of Medicine
  • IOKA Tatsuya
    Department of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute
  • FUKUTOMI Akira
    Department of Gastrointestinal Oncology, Shizuoka Cancer Center
  • MIZUNO Nobumasa
    Department of Gastroenterology, Aichi Cancer Center Hospital
  • OZAKA Masato
    Department of Gastroenterology, the Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • OKUSAKA Takuji
    Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital

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  • 切除不能膵癌に対する化学療法

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<p>Unresectable pancreatic cancer can be classified as locally advanced or metastatic, and the Clinical Practice Guidelines for Pancreatic Cancer 2019 recommend chemotherapy for patients with unresectable pancreatic cancer based on this classification. The optimal duration of chemotherapy is also recommended in the guidelines. Phase IIII trials of first-line chemotherapy, FOLFIRINOX or gemcitabine plus nab-paclitaxel (GnP) as compared to gemcitabine alone, have demonstrated that FOLFIRINOX or GnP offer prolonged overall survival as compared to gemcitabine alone, in patients with metastatic pancreatic cancer. Therefore, the two regimens are recommended as the first treatment of choice for patients with metastatic disease. Although no randomized controlled trials of FOLFIRINOX or GnP have been conducted to date for locally advanced pancreatic cancer, these two regimens are also recommended for the treatment of locally advanced disease at the same level as gemcitabine monotherapy or S-1 monotherapy.</p><p>Since second-line chemotherapy was proven to offer a survival benefit over supportive care in a randomized controlled trial, second-line chemotherapy is also recommended for patients with advanced pancreatic cancer. A fluoropyrimidine-based regimen is recommended after first-line use of a gemcitabine-based regimen, and a gemcitabine-based regimen is recommended after first-line use of a fluoropyrimidine-based regimen, such as FOLFIRINOX or S-1 chemotherapy. Pembrolizumab, a programmed cell death ligand-1inhibitor, is also recommended to treat tumors with high microsatellite instability, including pancreatic cancer. Chemotherapy should be continued until detection of progressive disease or emergence of intolerable adverse events.</p>

Journal

  • Suizo

    Suizo 35 (1), 69-74, 2020-02-28

    Japan Pancreas Society

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