Skip to main content
SpringerLink
Log in

Evidenz der Chemotherapie beim fortgeschrittenen Pankreaskarzinom

  • Chapter
  • First Online:
Erkrankungen des Pankreas

Zusammenfassung

Das fortgeschrittene Pankreaskarzinom gehört zu den bösartigsten Tumoren des Gastrointestinaltrakts und ist bei nahezu allen Patienten mit einem letalen Ausgang verbunden. Die palliative Behandlung dieser Erkrankung darf sich nicht allein auf die Chemotherapie fokussieren, sondern muss Ernährungstherapie, Schmerztherapie und Psychoonkologie frühzeitig mit einbeziehen. Die Gemcitabin-basierten Kombinationen mit Platinanalogen und Fluoropyrimidinen haben in der Gesamtheit der untersuchten Patienten im Vergleich zur Gemcitabin-Monotherapie keine substanzielle Überlebensverlängerung erreicht. Sie stellen daher allenfalls bei gutem Performance Status eine sinnvolle Therapieoption dar. Unter den molekularbiologisch gezielten Substanzen hat bisher nur der EGFR-Tyrosinkinase-Inhibitor Erlotinib eine Zulassung erhalten. Intensivere Polychemotherapien wie FOLFIRINOX oder Gemcitabin/nab-Paclitaxel haben in randomisierten Studien eine deutliche Überlegenheit gegenüber Gemcitabin gezeigt.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Boeck S, Heinemann V (2011) Anti-epidermal growth factor receptor treatment strategies in advanced pancreatic cancer: success or failure? J Clin Oncol 29: e70–71; author reply e72–73

    Google Scholar 

  • Boeck S, Heinemann V (2008) Second-line therapy in gemcitabine-pretreated patients with advanced pancreatic cancer. J Clin Oncol 26: 1178–1179

    Article  PubMed  Google Scholar 

  • Boeck S, Hinke A, Wilkowski R, Heinemann V (2007) Importance of performance status for treatment outcome in advanced pancreatic cancer. World J Gastroenterol 13: 224–227

    PubMed  Google Scholar 

  • Boeck S, Hoehler T, Seipelt G, Mahlberg R, Wein A, Hochhaus A et al (2008) Capecitabine plus oxaliplatin (CapOx) versus capecitabine plus gemcitabine (CapGem) versus gemcitabine plus oxaliplatin (mGemOx): final results of a multicenter randomized phase II trial in advanced pancreatic cancer. Ann Oncol 19: 340–347

    Article  PubMed  CAS  Google Scholar 

  • Burris H, Moore M, Anderson J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15: 2403–2413

    PubMed  CAS  Google Scholar 

  • Cascinu S, Berardi R, Labianca R, Siena S, Falcone A, Aitini E et al (2008) Cetuximab plus gemcitabine and cisplatin compared with gemcitabine and cisplatin alone in patients with advanced pancreatic cancer: a randomized, multicentre, phase II trial. Lancet Oncol 9: 39–44

    Article  PubMed  CAS  Google Scholar 

  • Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364: 1817–1825

    Article  PubMed  CAS  Google Scholar 

  • Conroy T, Paillot B, Francois E, Bugat R, Jacob JH, Stein U et al (2005) Irinotecan plus oxaliplatin and leucovorin-modulated fluorouracil in advanced pancreatic cancer – a Groupe Tumeurs Digestives of the Federation Nationale des Centres de Lutte Contre le Cancer study. J Clin Oncol 23: 1228–1236

    Article  PubMed  CAS  Google Scholar 

  • Cunningham D, Chau I, Stocken DD, Valle JW, Smith D, Steward W et al (2009) Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol 27: 5513–5518

    Article  PubMed  CAS  Google Scholar 

  • Custodio A, Puente J, Sastre J, Diaz-Rubio E (2009) Second-line therapy for advanced pancreatic cancer: a review of the literature and future directions. Cancer Treat Rev 35: 676–684

    Article  PubMed  CAS  Google Scholar 

  • Ducreux M, Rougier P, Pignon JP, Douillard JY, Seitz JF, Bugat R et al (2002) A randomised trial comparing 5-FU with 5-FU plus cisplatin in advanced pancreatic carcinoma. Ann Oncol 13: 1185–1191

    Article  PubMed  CAS  Google Scholar 

  • Edmonds C, Cengel KA (2008) Tumor-stroma interactions in pancreatic cancer. Will this SPARC prove a raging fire? Cancer Biol Ther 7: 1816–1817

    Article  PubMed  CAS  Google Scholar 

  • El-Rayes BF, Jasti P, Severson RK, Almhanna K, Philip PA, Shields A et al (2010) Impact of race, age, and socioeconomic status on participation in pancreatic cancer clinical trials. Pancreas 39: 967–971

    Article  PubMed  Google Scholar 

  • Fogelman D, Jafari M, Varadhachary GR, Xiong H, Bullock S, Ozer H et al (2011) Bevacizumab plus gemcitabine and oxaliplatin as first-line therapy for metastatic or locally advanced pancreatic cancer: a phase II trial. Cancer Chemother Pharmacol 68: 1431–1438

    Article  PubMed  CAS  Google Scholar 

  • Heinemann V, Boeck S, Hinke A, Labianca R, Louvet C (2008) Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer. BMC Cancer 8: 82

    Article  PubMed  Google Scholar 

  • Heinemann V, Quietzsch D, Gieseler F et al (2006) Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 24: 3946–3952

    Article  PubMed  CAS  Google Scholar 

  • Heinemann V, Vehling-Kaiser U, Waldschmidt D et al (2012) Gemcitabine plus erlotinib followed by capecitabine versus capecitabine plus erlotinib followed by gemcitabine in advanced pancreatic cancer: final results of a randomised phase 3 trial of the ‚Arbeitsgemeinschaft Internistische Onkologie‘ (AIO-PK0104). Gut 2012, epub

    Google Scholar 

  • Hess V, Pratsch S, Potthast S, Lee L, Winterhalder R, Widmer L et al (2010) Combining gemcitabine, oxaliplatin and capecitabine (GEMOXEL) for patients with advanced pancreatic carcinoma (APC): a phase I/II trial. Ann Oncol 21: 2390–2395

    Article  PubMed  CAS  Google Scholar 

  • Hidalgo M (2010) Pancreatic cancer. N Engl J Med 362: 1605–1617

    Article  PubMed  CAS  Google Scholar 

  • von Hoff DD, Ervin TJ, Arena FP et al (2012) Randomized phase III study of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic adenocarcinoma of the pancreas (MPACT). J Clin Oncol 30 (Suppl 34: abstr LBA148

    Google Scholar 

  • von Hoff DD, Ramanathan RK, Borad MJ, Laheru DA, Smith LS, Wood TE et al (2011) Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: A phase I/II trial. J Clin Oncol 29: 4548–4554

    Article  PubMed  CAS  Google Scholar 

  • Infante JR, Matsubayashi H, Sato N, Tonascia J, Klein AP, Riall TA et al (2007) Peritumoral fibroblast SPARC expression and patient outcome with resectable pancreatic adenocarcinoma. J Clin Oncol 25: 319–325

    Article  PubMed  Google Scholar 

  • Javle M, Yu J, Garrett C, Pande A, Kuvshinoff B, Litwin A et al (2009) Bevacizumab combined with gemcitabine and capecitabine for advanced pancreatic cancer: a phase II study. Br J cancer 100: 1842–1845

    Google Scholar 

  • Kindler HL, Ioka T, Richel DJ, Bennouna J, Letourneau R, Okusaka T et al (2011) Axitinib plus gemcitabine versus placebo plus gemcitabine in patients with advanced pancreatic adenocarcinoma: a double-blind randomised phase 3 study. Lancet Oncol 12: 256–262

    Article  PubMed  CAS  Google Scholar 

  • Ko AH, Youssoufian H, Gurtler J, Dicke K, Kayaleh O, Lenz HJ et al (2011) A phase II randomized study of cetuximab and bevacizumab alone or in combination with gemcitabine as first-line therapy for metastatic pancreatic adenocarcinoma. Invest New Drugs 30: 1597–1606

    Article  PubMed  Google Scholar 

  • Kullmann F, Hartmann A, Stöhr R, Messmann H, Dollinger MM, Trojan J et al (2011) KRAS mutation in metastatic pancreatic ductal adenocarcinoma: results of a multicenter phase II study evaluating efficacy of cetuximab plus gemcitabine/oxaliplatin (GEMOXCET) in first-line therapy. Oncology 81 3–8

    Article  PubMed  CAS  Google Scholar 

  • Louvet C, Labianca R, Hammel P, Lledo G, Zampino MG, Andre T et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23: 3509–3516

    Article  PubMed  CAS  Google Scholar 

  • Manzano J, Rivera F, Galan M, Valladares M, Pericay C, Mendez MJ et al (2010) A phase II, open label study to evaluate the relationship between skin rash and survival in patients with unresectable and/or metastatic pancreatic cancer treated with erlotinib combined with gemcitabine. J Clin Oncol 28 (15s): abstract 4094

    Google Scholar 

  • Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25: 1960–1966

    Article  PubMed  CAS  Google Scholar 

  • Neesse A, Michl P, Frese KK, Feig C, Cook N, Jacobetz MA et al (2011) Stromal biology and therapy in pancreatic cancer. Gut 60: 861–868

    Article  PubMed  Google Scholar 

  • Pelzer U, Kubica K, Stieler J, Schwaner I, Heil G, Görner M et al (2008) A randomized trial in patients with gemcitabine refractory pancreatic cancer. Final results of the CONKO 003 study. J Clin Oncol 26 (Suppl): abstract 4508

    Google Scholar 

  • Philip P (2011) Reply to S. Boeck et al. J Clin Oncol 29: e72–e73

    Google Scholar 

  • Philip PA, Mooney M, Jaffe D, Eckhardt G, Moore M, Meropol N et al (2009) Consensus report of the national cancer institute clinical trials planning meeting on pancreas cancer treatment. J Clin Oncol 27: 5660–5669

    Article  PubMed  Google Scholar 

  • Reni M, Cordio S, Milandri C, Passoni P, Bonetto E, Oliani C et al (2005) Gemcitabine versus cisplatin, epirubicin, fluorouracil, and gemcitabine in advanced pancreatic cancer: a randomised controlled multicentre phase III trial. Lancet Oncol 6: 369–376

    Article  PubMed  CAS  Google Scholar 

  • Rocha Lima CM, Green MR, Rotche R, Miller WH Jr, Jeffrey GM, Cisar LA et al (2004) Irinotecan plus gemcitabine results in no survival advantage compared with gemcitabine monotherapy in patients with locally advanced or metastatic pancreatic cancer despite increased tumor response rate. J Clin Oncol 22: 3776–3783

    Article  PubMed  CAS  Google Scholar 

  • Spano JP, Chodkiewicz C, Maurel J, Wong R, Wasan H, Barone C et al (2008) Efficacy of gemcitabine plus axitinib compared with gemcitabine alone in patients with advanced pancreatic cancer: an open-label randomised phase II study. Lancet 371: 2101–2108

    Article  PubMed  CAS  Google Scholar 

  • Stathopoulos GP, Syrigos K, Aravantinos G, Polyzos A, Papakotoulas P, Fountzilas G et al (2006) A multicenter phase III trial comparing irinotecan-gemcitabine (IG) with gemcitabine (G) monotherapy as first-line treatment in patients with locally advanced or metastatic pancreatic cancer. Br J Cancer 95: 587–592

    Article  PubMed  CAS  Google Scholar 

  • Sultana A, Smith CT, Cunningham D, Starling N, Neoptolemos JP, Ghaneh P (2007) Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25: 2607–2615

    Article  PubMed  Google Scholar 

  • Taieb J, Lecomte T, Aparicio T, Asnacios A, Mansourbakht T, Artru P et al (2007) FOLFIRI.3, a new regimen combining 5-fluorouracil, folinic acid and irinotecan, for advanced pancreatic cancer: results of an Association des Gastro-Enterologues Oncologues (Gastroenterologist Oncologist Association) multicenter phase II study. Ann Oncol 18: 498–503

    Article  PubMed  CAS  Google Scholar 

  • Van Cutsem E, Vervenne WL, Bennouna J, Humblet Y, Gill S, Van Laethem JL et al (2009) Phase III trial of bevacizumab in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. J Clin Oncol 27: 2231–2237

    Article  PubMed  CAS  Google Scholar 

  • Verslype C, Verwvenne W, Bennouna J, Humblet Y, Cosaert J, van Cutsem E (2009) Rash as a marker for the efficacy of gemcitabine plus erlotinib-based therapy in pancreatic cancer: results from the AViTA Study. J Clin Oncol 27 (15s): abstract 4532

    Google Scholar 

  • Wagner AD, Buechner-Steudel P, Wein A, Schmalenberg H, Lindig U, Moehler M et al (2007) Gemcitabine, oxaliplatin and weekly high-dose 5-FU as 24-h infusion in chemonaive patients with advanced or metastatic pancreatic adenocarcinoma: a multicenter phase II trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Ann Oncol 18: 82–87

    Article  PubMed  CAS  Google Scholar 

  • Wasan HS, Springett GM, Chodkiewicz C, Wong R, Maurel J, Barone C et al (2009) CA 19-9 as a biomarker in advanced pancreatic cancer patients randomised to gemcitabine plus axitinib or gemcitabine alone. Br J Cancer 101: 1162–1167

    Article  PubMed  CAS  Google Scholar 

  • Wong D, Ko AH, Hwang J et al (2008) Serum CA19-9 decline compared to radiographic response as a surrogate for clinical outcomes in patients with metastatic pancreatic cancer receiving chemotherapy. Pancreas 37: 269–274

    Article  PubMed  Google Scholar 

  • Xiong HQ, Varadhachary GR, Blais JC, Hess KR, Abbruzzese JL, Wolff RA (2008) Phase 2 trial of oxaliplatin plus capecitabine (XELOX) as second-line therapy for patients with advanced pancreatic cancer. Cancer 113: 2046–2052

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik III und Comprehensive Cancer Center, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland

    Volker Heinemann

Authors
  1. Volker Heinemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Volker Heinemann .

Editor information

Editors and Affiliations

  1. Abt. Allgemeine- und Visceralchirurgie, Universitätsklinikum Ulm, Germany

    Hans G. Beger

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Germany

    Markus W. Büchler

  3. Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Sachsen-Anhalt, Germany

    Henning Dralle

  4. Klinik und Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Germany

    Markus M. Lerch

  5. und Hepatologie (KGHI), Universitätsklinikum Magdeburg, Germany

    Peter Malfertheiner

  6. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig, Sachsen, Germany

    Joachim Mössner

  7. ehemals Klinikum der Stadt Ludwigshafen gGmbH, Rheinland-Pfalz, Germany

    Jürgen F. Riemann

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Heinemann, V. (2013). Evidenz der Chemotherapie beim fortgeschrittenen Pankreaskarzinom. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_71

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-37964-2_71

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37963-5

  • Online ISBN: 978-3-642-37964-2

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation