Healthcare Professionals

Chemotherapy

Systemic chemotherapy in metastatic pancreatic cancer needs several considerations as:

• The cancer is resistant to routine treatment and the treatment outcome is poor.
• The overall health status of the patients is poor: most of them are in pain, are weak and have already lost considerable weight.
• The patients may not be able to tolerate rigorous chemotherapy cycles.
• The patients may have compromised liver functions that increase risk and toxic effects of chemotherapy.

Studies have established the beneficial effects of systemic chemotherapy in improving survival time and quality of life in patients with metastasised cancer.

• Gemcitabine is the standard drug used for therapy with or without addition of other drugs. Gemcitabine has been found to increase the progression free interval and overall survival time in advanced cancer.
• Some studies report that fixed dose rate infusion does not offer any significant benefit over the 30 minute single infusion as per standard therapy²⁰, and addition of a second drug to gemcitabine therapy also does not have a significant advantage as compared to gemcitabine alone. However, addition of 5-FU, cisplatin or platinum compound to gemcitabine was found to improve the survival time in patients with advanced disease but in relatively good health condition.
• Trials on gemcitabine- capecitabine and gemcitabine- erlotinib have demonstrated some improvement in overall survival but the effect on progress of disease was not significant.
• Gemcitabine- erlotinib was found to be beneficial in patients who had cutaneous reactions with erlotinib.
• Erlotinib in combination with capecitabine in metastatic cancer refractory to gemcitabine was reported to be well tolerated and effective.²¹

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