Pancreatic cancer: a review of recent advances

Pancreatic cancer is one of the most common causes of cancer-related death. Despite the advances of the molecular pathogenesis, pancreatic cancer remains a major unsolved health problem. Overall, the 5-year survival rate is < 5% and only approximately 20% of the 10% of patients with resectable disease survive 5 years. Recently, the European Study Group for Pancreatic Cancer 1 trial demonstrated substantially increased survival from adjuvant chemotherapy with 5-fluorouracil-folinic acid and preliminary data showed prolonged disease-free survival from adjuvant gemcitabine. Current palliative therapeutic approaches mostly focused on evaluating chemotherapy regimens in which gemcitabine is combined with a second cytotoxic agent. Recently, large randomised trials of combinations of gemcitabine with either capecitabine or with erlotinib demonstrated prolonged survival and 1-year survival rates of approximately 25%. The advance of molecular biology has led to the elucidation of molecular events that are important for pancreatic carcinogenesis and has provided a foundation for the development of novel chemotherapeutic and biological agents that appear to be promising and are likely to play a future role in the treatment of patients with advanced pancreatic cancer.     

Pancreatic cancer: a review of recent advances

Pancreatic cancer is one of the most common causes of cancer-related death. Despite the advances of the molecular pathogenesis, pancreatic cancer remains a major unsolved health problem. Overall, the 5-year survival rate is < 5% and only ～ 20% of the 10% of patients with resectable disease survive 5 years. Recently, the European Study Group for Pancreatic Cancer 1 trial demonstrated substantially increased survival from adjuvant chemotherapy with 5-fluorouracil–folinic acid and preliminary data showed prolonged disease-free survival from adjuvant gemcitabine. Current palliative therapeutic approaches mostly focused on evaluating chemotherapy regimens in which gemcitabine is combined with a second cytotoxic agent. Recently, large randomised trials of combinations of gemcitabine with either capecitabine or with erlotinib demonstrated prolonged survival and 1-year survival rates of ～ 25%. The advance of molecular biology has led to the elucidation of molecular events that are important for pancreatic carcinogenesis and has provided a foundation for the development of novel chemotherapeutic and biological agents that appear to be promising and are likely to play a future role in the treatment of patients with advanced pancreatic cancer.     

局部晚期鼻咽癌BPP方案同期放化疗与常规放化疗比较

目的:比较BPP方案同期放化疗加辅助化疗和PF方案诱导化疗加放疗加辅助化疗在局部晚期鼻咽癌治疗的效果与毒副作用。方法:回顾性分析154例接受放化结合治疗的局部晚期鼻咽癌患者。其中74例采用BPP方案同期放化疗加辅助化疗(A组);80例采用PF方案诱导化疗加放疗加辅助化疗(B组)。放疗采用常规技术。结果:全程治疗结束后3mo肿瘤疗效评价:A、B组完全缓解率分别为97·3%、88·8%(P<0·05),3a总生存率分别为79·7%、76·4%(P>0·05),无远处转移生存率分别为72·8%、74·9%(P>0·05),无疾病进展生存率分别为71·7%、66·7%(P>0·05)。A组和B组2～3级恶心、呕吐发生率分别为47·3%、57·5%(P>0·05),白细胞减少的发生率分别为43·3%、27·5%(P<0·05),皮肤反应发生率分别为73·0%、87·5%(P<0·05),口腔黏膜反应发生率分别为66·2%、86·2%(P<0·01)。结论:采用BPP方案同期放化疗治疗局部晚期鼻咽癌近期疗效优于PF方案。3a生存率2组无差异。A组血液毒性较高,B组皮肤黏膜反应较重。     

The role of adjuvant therapy for pancreatic cancer

Patients with pancreatic cancer have a very poor outlook. There have been major advances in the standard surgical treatment of this disease, resulting in decreased post-operative mortality and morbidity. The use of chemotherapy and radiotherapy has been developed to increase long-term patient survival following potentially curative resection. The standard chemotherapeutic agent is 5-fluorouracil (5-FU), although newer cytotoxic agents are in clinical trials for advanced cancer. Initial studies of adjuvant therapy have been based on small numbers of patients, but recently two large European randomised controlled trials of adjuvant therapy (EORTC and ESPAC-1) have been completed. These suggest that adjuvant chemotherapy has a significant survival advantage over resection alone but chemoradiotherapy does not. Promising new agents are being developed and tested mainly in clinical trials of advanced pancreatic cancer. The results of large-scale randomised controlled trials to assess adjuvant therapies for pancreatic cancer demonstrate the great surgical and oncological progress that has been made over the past decade.     

Treatment of non-localised, non-metastatic rectal cancer

The standard treatment for rectal cancer is surgical removal of the rectum and mesorectum. Is the prognosis for non-metastatic rectal cancer that extends beyond the bowel wall improved by adding radiotherapy and/or chemotherapy to surgery? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. Randomised trials conducted before optimal surgery was developed showed that, compared with surgery alone, postoperative radiotherapy reduced the risk of local recurrence and possibly increased overall survival. In the only randomised trial in which the mesorectum was systematically removed, preoperative radiotherapy had no impact on overall survival but reduced the risk of local recurrence (5% at 10 years, versus 11% without radiation therapy).This result was statistically significant in patients with lymph node involvement. Radiotherapy for rectal cancer carries a risk of faecal incontinence (about 50% of patients), small bowel occlusion, and secondary cancers (about 1 in 15 patients). In patients who receive neither radiotherapy nor chemotherapy before surgery, postoperative chemotherapy based on fluorouracil or the tegafur + uracil combination increases overall survival by about 5% at 5 years, in absolute numbers, but carries a risk of serious adverse effects, including haematological and gastrointestinal disorders. Eight randomised trials suggest that the beneficial effects of post-operative chemotherapy and radiotherapy persist and are additive. However, the same is true for adverse effects. In four randomised trials, adding chemotherapy to preoperative radiotherapy roughly halved the risk of local recurrence. In three randomised trials, preoperative chemoradiotherapy appeared to be slightly more effective than postoperative chemoradiotherapy in terms of recurrence, and to carry a similar or lower risk of serious adverse effects, without improving overall survival. Preoperative chemoradiotherapy carries a risk of unnecessarily exposing between 8% and 18% of patients to adverse effects, as their tumour is found to be less extensive than initially thought. There is no firm evidence that postoperative chemotherapy is beneficial after preoperative radiotherapy. Preoperative treatments do not prevent removal of the anal sphincter. The probable benefits of adjuvant therapies in surgical patients must be weighed, on a case by case basis, against the potential risk of serious adverse effects and complications.     

Emerging drugs in pancreatic cancer

Improving survival in patients with pancreatic cancer remains a formidable challenge. For the few patients with localised stages of the disease, intra-operative radiotherapy, adjuvant chemoradiotherapy and neo-adjuvant therapies remain non-validated and the survival benefit conferred by 5-fluorouracil-folinic acid adjuvant chemotherapy over radical surgery alone is still a matter of debate. Gemcitabine has recently emerged as the standard single agent in advanced stages of the disease and pharmacokinetic refinements such as the use of a fixed-dose infusion rate may further improve still rather modest result figures. At present, most efforts deal with the development of more effective doublet or triplet therapies, combining gemcitabine with either conventional cytotoxic drugs--the most promising being oxaliplatin--or more innovative, targeted therapeutic agents. Among these agents, matrix metalloprotease inhibitors and farnesyltransferase inhibitors have already undergone Phase III trials, alone or in combination with gemcitabine, with rather disappointing results. However, preclinical and Phase I and II studies of cyclooxygenase-2 or lipoxygenase inhibitors, various immunotherapeutic approaches and several tyrosine kinase inhibitors or monoclonal antibodies against growth factors or their receptors are encouraging and may provide some hope for patients with pancreatic cancer.     

晚期鼻咽癌放疗联合辅助性化疗的临床研究

目的 分析评价晚期（N2,N3期）鼻咽癌放疗加辅助化疗的疗效.方法 86例N2,N3期鼻咽癌患者随机分为放化组（A组,46例）和单放组（B组,40例）,均首先接受根治性放疗,其后放化组46例接受辅助化疗（LV＋5Fu＋DDP）3～4个疗程.结果 放化组5年生存率43.5%,单放组37.5%（P＞0.05）;放化组远处转移发生率19.6%,单放组45%（P＜0.05）;放化组远处转移发生时间平均放疗后18.3个月,单放组7.8个月;放疗后达到CR的放化组与单放组的5年生存率为42.9%、56.5%（P＞0.05）,非CR的放化组与单放组的5年生存率为44.4%、11.8%（P＜0.05）.结论 放疗加辅助性化疗N2,N3期鼻咽癌有助于延缓远处转移发生时间,减少远处转移;对于根治性放疗后未达CR者,辅助化疗能提高生存率.     

Neoadjuvant chemotherapy in non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is a systemic illness. More than half of those patients who present with stage I-IIIA disease and are resected will experience distant relapse. Postoperative adjuvant chemotherapy has been evaluated in several randomized trials but the results of these trials have been inconclusive with increased survival reported in few trials. In resectable stage IIIA NSCLC the findings of three randomized trials have indicated that the survival of these patients is better with neoadjuvant chemotherapy plus surgical resection than with resection alone. Phase II trials using preoperative concurrent chemoradiotherapy have been carried out with encouraging results. The majority of patients with stage IIIA NSCLC require multimodality therapy if they are to achieve a 5-year survival. Combined modality treatment in locally advanced NSCLC continues to evolve and is a subject of ongoing research. One focus for present research is to integrate new active agents into the neoadjuvant setting. Another challenge is to find better treatment approaches in earlier stages of disease. Some data suggest that induction chemotherapy in stage I-II is feasible, does not appear to compromise surgery and yields high response rates. A further aim is to use molecular biological markers of malignancy to identify patients at highest risk of metastatic relapse.     

Adjuvant therapy for pancreatic cancer

Ductal adenocarcinoma of the pancreas is one of the leading causes of cancer death in the UK, Europe and US, with incidence closely paralleling mortality. Until recently, enthusiasm for treating these patients was limited for a number of reasons: the majority of patients undergoing surgery would relapse early, adjuvant treatment was of unproven value and systemic therapy in advanced disease had only a small chance of a short-term benefit. More recently, however, it has become recognised that specialist surgery can improve results and there is evidence that adjuvant chemotherapy has a significant advantage in terms of 5-year survival. In particular adjuvant systemic 5-fluorouracil with folinic acid can result in 5-year survival of < or = 29% (compared with 11% for controls) and adjuvant gemcitabine can improve disease-free survival to 13.4 months from a median of 6.9 months in controls, but not overall survival. In contrast the role of adjuvant chemoradiation in addition to chemotherapy remains unproven and the survival results appear to be inferior to systemic chemotherapy alone. New agents, such as capecitabine and erlotinib, are emerging with some activity in this dismal disease signalling hope for the future.     

Adjuvant therapy for pancreatic cancer

Ductal adenocarcinoma of the pancreas is one of the leading causes of cancer death in the UK, Europe and US, with incidence closely paralleling mortality. Until recently, enthusiasm for treating these patients was limited for a number of reasons: the majority of patients undergoing surgery would relapse early, adjuvant treatment was of unproven value and systemic therapy in advanced disease had only a small chance of a short-term benefit. More recently, however, it has become recognised that specialist surgery can improve results and there is evidence that adjuvant chemotherapy has a significant advantage in terms of 5-year survival. In particular adjuvant systemic 5-fluorouracil with folinic acid can result in 5-year survival of ≤ 29% (compared with 11% for controls) and adjuvant gemcitabine can improve disease-free survival to 13.4 months from a median of 6.9 months in controls, but not overall survival. In contrast the role of adjuvant chemoradiation in addition to chemotherapy remains unproven and the survival results appear to be inferior to systemic chemotherapy alone. New agents, such as capecitabine and erlotinib, are emerging with some activity in this dismal disease signalling hope for the future.     

Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的影响因素分析

目的 探讨影响Ⅱ~Ⅲ期食管癌根治性切除术后患者预后的因素。方法 回顾性分析 2007年 1月—2010年 12月行食管癌根治性切除术且术后病理分期为Ⅱ~Ⅲ期共 716例患者的临床资料。选择可能影响预后的临床病理资料及术后治疗情况进行单因素和多因素分析。结果 716 例患者 1、3、5 年总生存率分别为 79.85%、58.27%、 49.73%。多因素分析显示：性别、术中粘连程度、术后阳性淋巴结数目、T分期及术后辅助治疗是影响患者总生存时间（OS）的独立预后因素（均 P＜0.05）。对术后辅助治疗方式进行分层分析显示：Ⅱa期（342例）患者术后化疗组 OS优于单纯手术组和术后放疗组（χ2分别为 9.301、4.422,P＜0.05或P＜0.01）;Ⅱb（75例）及Ⅲ期（299例）患者术后放化疗组及术后放疗组 OS均优于单纯手术组（Ⅱb期：χ2分别为 3.926、4.605,P＜0.05;Ⅲ期：χ2分别为 8.504、7.435,P＜0.01）。716例患者 1、3、5年无进展生存率分别为 71.23%、49.32%、38.26%。多因素分析显示：性别、术中粘连程度、TNM分期及术后辅助治疗是影响患者无进展生存时间（PFS）的独立预后因素（均P＜0.05）。对术后辅助治疗方式进行分层分析显示：Ⅱa期患者术后化疗组 PFS优于单纯手术组（χ2=7.481,P＜0.01）;Ⅱb及Ⅲ期患者术后放化疗组 PFS均优于单纯手术组（χ2分别为 6.684、5.741,P＜0.05）。结论 根治术后辅助治疗为影响Ⅱ~Ⅲ期食管癌患者预后的重要因素。Ⅱa期患者可仅行术后化疗,而Ⅱb～Ⅲ期患者接受辅助放疗或放化疗可获得更优预后。     

Capecitabine: an evidence-based review of its effectiveness in the treatment of carcinoma of the pancreas

Introduction:

More than 90% of patients with pancreatic cancer present either with incurable locally advanced or metastatic disease or relapse following surgery. For these patients systemic therapy offers the only prospect of salvage, but pancreatic cancer is one of the most chemoresistant of tumors; current chemotherapy can only delay progression in a limited proportion of patients and survival rates are poor. There is therefore a pressing need for more effective therapy. Capecitabine is a new oral prodrug of fluorouracil, which has shown activity in pancreatic cancer particularly when used in combination with gemcitabine.

Aims:

To review the emerging evidence for the clinical effectiveness of capecitabine in the management of carcinoma of the pancreas.

Evidence review:

There is evidence from phase II testing that capecitabine is active in pancreatic cancer. The Swiss Group for Clinical Cancer Research/Central European Cooperative Oncology Group (SAKK/CECOG) phase III trial found that the combination of gemcitabine and capecitabine did not improve overall median survival as compared with gemcitabine alone (8.4 vs 7.3 months, respectively; P=0.314) but subgroup analysis in patients with good performance score [Karnofsky Performance Scores (KPS) ≥90] revealed a significant survival improvement with the combination arm (10.1 months) compared with single-agent gemcitabine (7.5 months; P=0.033). Preliminary data from the GemCap phase III trial indicated significantly improved response rates and survival for the combination of gemcitabine with capecitabine (7.4 months) compared with gemcitabine alone (6 months; P=0.026) but analysis of the mature data with adequate follow-up awaits reporting.

Clinical potential:

The addition of capecitabine to gemcitabine may represent a small step forward in the management of advanced pancreatic cancer but further data are required in order to determine its full impact.     

同步放化疗治疗中晚期宫颈癌临床观察

目的探讨同步放化疗与单纯同步放疗对中晚期宫颈癌患者的疗效。方法将2000年5月至2003年5月本科收治的中晚期宫颈癌患者68例,随机分为A组（同步放化疗组）36例,B组（单纯放疗组）32例,将2组的治疗后肿瘤消退情况、生存率、复发率及远处转移情况和不良反应进行比较。结果治疗3月后A组和B组肿瘤消退治疗有效率差异有显著性意义（91．66％,68．75％,P〈0．05）;A组和B组3年生存率比较有显著差异性（80．55％,53．12％,P〈0．05）;A、B两组组复发率、远处转移率差异均有显著性意义（8．33％,15．63％;11．11％,28．13％;P〈0．01）。化疗不良反应较著,但是差异无显著性意义（P〉0．05）。结论与单纯同步放疗比较,同步放化疗对中晚期宫颈癌的效果更好。     

Conventional cytotoxic and novel therapeutic concepts in colorectal cancer

Colorectal cancer (CRC) is a major cause of death, particularly in the Western world, leading to 400,000 deaths each year [1]. Of the patients, 30% have advanced disease at presentation, either locally or at distant sites and chemotherapy in this setting has an established role in improving survival and palliating symptoms [2]. In addition, approximately 50% of those patients initially believed to be cured by surgery, subsequently relapse and die of their disease. Adjuvant chemotherapy administered for six months after surgery for Dukes C colon cancer improves absolute survival by 5 - 10% [3]. However, the role of adjuvant chemotherapy in Dukes B colon or Dukes B/C rectal tumours is still controversial and is only recommended within the scope of a randomised clinical trial. Cytotoxic drug development for colorectal cancer has traditionally followed the established pathway of Phase I, Phase II and then Phase III trials in advanced disease, with subsequent translation into the adjuvant setting. For the purpose of this review current conventional chemotherapy for advanced CRC is described, followed by an explanation of newer developments that are predicated upon our increasing understanding of the molecular processes underpinning malignant transformation, invasion and metastasis. Paradigm shifts in trial design necessitated by a mechanistic approach to drug development are also discussed.     

Incidence and management of bevacizumab-related toxicities in colorectal cancer

Bevacizumab, a recombinant, humanised monoclonal antibody against vascular endothelial growth factor, when used in combination with intravenous 5-fluorouracil (5-FU)-based chemotherapy as first-line treatment of metastatic colorectal cancer (CRC) improves survival. In a randomised, placebo-controlled Phase III study, the addition of bevacizumab to irinotecan/5-FU/leucovorin (IFL) resulted in significant improvement in survival compared with IFL alone, which led to its approval for first-line use in CRC. Bevacizumab also demonstrates improved efficacy in combination with 5-FU/LV over chemotherapy alone when data were pooled from two randomised Phase II studies utilising bevacizumab with 5-FU/leucovorin, and also in a third treatment arm of bevacizumab/5-FU/LV of a randomised Phase III study. More recently, in the second-line setting, bevacizumab in combination with FOLFOX improved survival from 10.8 to 12.9 months in the ECOG 3200 trial. Clinical activity with the addition of bevacizumab to oxaliplatin and either 5-FU or capecitabine-based regimens has also been shown in TREE-2, and activity with the combination of bevacizumab and the EGFR inhibitor cetuximab has been documented in BOND-2. In this study, bevacizumab was generally well-tolerated with no unexpected toxicities when combined with cetuximab. A few toxicities were uniformly encountered in all of the above studies, in particular grade 3 medically-manageable hypertension (3 - 16%). In addition, other toxicities were haemorrhage (2 - 9.3%), gastrointestinal perforation (1.5%), arterial thromboembolism (3.8%), wound healing (1 - 2%) and proteinuria (1 - 2%). As bevacizumab is becoming widely used in general oncology practice, it is important to understand the toxicities which can arise and to develop practice guidelines for their management. This review addresses the toxicities noted in trials using bevacizumab for the treatment of CRC and provides recommendations for toxicity management.     

Incidence and management of bevacizumab-related toxicities in colorectal cancer

Bevacizumab, a recombinant, humanised monoclonal antibody against vascular endothelial growth factor, when used in combination with intravenous 5-fluorouracil (5-FU)-based chemotherapy as first-line treatment of metastatic colorectal cancer (CRC) improves survival. In a randomised, placebo-controlled Phase III study, the addition of bevacizumab to irinotecan/5-FU/leucovorin (IFL) resulted in significant improvement in survival compared with IFL alone, which led to its approval for first-line use in CRC. Bevacizumab also demonstrates improved efficacy in combination with 5-FU/LV over chemotherapy alone when data were pooled from two randomised Phase II studies utilising bevacizumab with 5-FU/leucovorin, and also in a third treatment arm of bevacizumab/5-FU/LV of a randomised Phase III study. More recently, in the second-line setting, bevacizumab in combination with FOLFOX improved survival from 10.8 to 12.9 months in the ECOG 3200 trial. Clinical activity with the addition of bevacizumab to oxaliplatin and either 5-FU or capecitabine-based regimens has also been shown in TREE-2, and activity with the combination of bevacizumab and the EGFR inhibitor cetuximab has been documented in BOND-2. In this study, bevacizumab was generally well-tolerated with no unexpected toxicities when combined with cetuximab. A few toxicities were uniformly encountered in all of the above studies, in particular grade 3 medically-manageable hypertension (3 – 16%). In addition, other toxicities were haemorrhage (2 – 9.3%), gastrointestinal perforation (1.5%), arterial thromboembolism (3.8%), wound healing (1 – 2%) and proteinuria (1 – 2%). As bevacizumab is becoming widely used in general oncology practice, it is important to understand the toxicities which can arise and to develop practice guidelines for their management. This review addresses the toxicities noted in trials using bevacizumab for the treatment of CRC and provides recommendations for toxicity management.     

Adjuvant hormone therapy for breast cancer: alternatives to tamoxifen

(1) After surgical excision of hormone-receptor-positive non metastatic breast cancer in postmenopausal women, a meta-analysis of 55 trials has shown that adjuvant tamoxifen, 20 mg/day for 5 years, reduces the risk of relapse by 8% and the risk of death by 5% (absolute values). The benefit of treatment beyond 5 years remains to be established. (2) Preliminary four-year results from a double-blind randomised controlled trial comparing anastrozole with tamoxifen (ATAC trial) indicated an advantage for anastrozole in reducing the risk of relapse. There was no difference in survival rate. Women taking anastrozole experienced more sexual dysfunction and an increased risk of osteoporotic fractures, whereas tamoxifen was associated with an increased risk of thrombosis and endometrial cancer. The trial's methodology is controversial, however, and conclusions concerning the relative risk-benefit balances of these two drugs must await the full 5-year results. (3) A double-blind placebo-controlled trial of letrozole, prescribed after 5 years of adjuvant tamoxifen, was stopped early after a median follow-up of 2.4 years. When extrapolated to 4 years, the results suggest that letrozole reduced the risk of relapse (7%, compared to 13% with tamoxifen) but had no effect on survival. (4) A double-blind trial comparing tamoxifen with exemestane in 4742 women who had already received tamoxifen for two to three years showed a higher three-year disease-free survival rate with exemestane (91.5% versus 86.8%). Overall survival did not differ between the two groups. (5) Pending results of further clinical trials, tamoxifen remains the first-line adjuvant hormone therapy for most postmenopausal women with hormone-receptor-positive non metastatic breast cancer.     

The role of gemcitabine alone and in combination in the treatment of pancreatic cancer

Pancreatic cancer, one of the most frequently reported gastrointestinal tumors, has a 5-year survival of less than 5%. Despite representing only 2-3% of the total cancer incidence, it is the fifth leading cause of cancer death. This is because it is commonly only diagnosed at an advanced stage. Until recently the traditional therapy for patients with advanced disease was palliative 5-fluorouracil (5-FU)-based chemotherapy. However, the novel antinucleoside gemcitabine (Gemzar) has demonstrated a survival benefit over 5-FU, and an improvement in disease-related symptoms and quality of life in patients with advanced disease. This review presents an overview of the clinical studies of gemcitabine, either alone or in combination, with other chemotherapeutic agents and/or radiation therapy, in the treatment of these patients. A comparison of these studies is made with those using alternative treatment regimens. The data suggest that gemcitabine in combination with biomodulated 5-FU should be considered the standard palliative treatment to which other new drug combinations or combined modality chemoradiation regimens should be compared.     

Development of nanoliposomal irinotecan (nal-IRI,MM-398, PEP02) in the management of metastatic pancreatic cancer

Introduction: Systemic chemotherapy remains the standard of care for patients with advanced pancreatic ductal adenocarcinoma (PDAC). The introductions of FOLFIRINOX and nab-paclitaxel/gemcitabine combinations have improved the first-line treatment outcomes of patients with metastatic PDAC; while second-line therapy options are limited. Based on the results of pivotal NAPOLI-1 study, nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (5-FU/LV) became the first US Food and Drug Administration (FDA) approved regimen for patients with metastatic PDAC with previous gemcitabine-based chemotherapy in November 2015.

Areas covered: We reviewed and summarized the rationale, pharmacokinetics, therapeutic efficacy and adverse events of nal-IRI alone or combined with 5-FU/LV for metastatic PDAC with previous gemcitabine-based chemotherapy.

Expert opinion: In the NAPOLI study, nal-IRI plus 5-FU/LV significantly improved the overall survival, progression-free survival and objective response rate compared to 5-FU/LV alone. The nal-IRI plus 5-FU/LV treatment was associated with a manageable toxicity profile and comparable outcomes in patients with negative demographic characteristics. The relatively sparse of neurotoxicity makes nal-IRI plus 5-FU/LV as a more favorable option than oxaliplatin-containing regimens and the current recommended standard treatment for patients with metastatic PDAC after frontline nab-paclitaxel/gemcitabine treatment. The front-line therapeutic role of nal-IRI is currently under investigation.     

复方苦参注射液联合同步放化疗治疗中晚期食道癌的临床观察

目的:观察复方苦参注射液联合同步放化疗治疗中晚期食道癌的近期疗效和放化疗不良反应。方法:将72例中晚期食道癌患者随机分为对照组和试验组各36例,2组均采用同步放化疗:放疗总量为64～68 Gy(6～7周),且在放疗d1、d29予以2次FP方案化疗,为DDP 20 mg·m-2,d1～4和5-FU 500 mg·m-2,d1～5。试验组在上述给药基础上再静脉注射复方苦参注射液20 mL,d1～10、d29～39。结果:试验组的近期有效率为81%,对照组为75%,2组无明显差异;试验组放化疗不良反应明显减轻,2组有显著差异(P<0.05)。结论:复方苦参注射液联合同步放化疗治疗中晚期食道癌可减轻放化疗的不良反应。