胰腺癌术后辅助药物治疗的研究进展

doi:10.11904/j.issn.1002-3070.2020.03.011

摘要/Abstract

摘要： 胰腺癌是一种致死性极高的恶性肿瘤,其5年生存率不到8%。可行根治性手术的胰腺癌患者较未行手术者预后有显著差异,单纯的手术治疗仅能将胰腺癌5年生存率提高至10%左右,究其原因主要是单纯手术后复发、转移的几率仍然极高,且复发、转移后患者生活质量欠佳,预后极差,远期生存时间短。因此,寻求胰腺癌术后更加有效的辅助治疗药物或者方案,并进行规范、合理、综合的药物治疗,控制微转移,对防止和延迟复发意义重大,该研究领域也是近年来针对胰腺癌研究的重点方向。本文基于近年来胰腺癌术后治疗的研究进展做一综述。探索胰腺癌术后不同药物、不同治疗方案下的生存获益情况及胰腺癌术后治疗的药物发展趋势,为胰腺癌术后治疗提供有价值的参考。

关键词: 术后辅助治疗, 胰腺癌, 化疗, 靶向治疗, 免疫治疗

Abstract: Pancreatic cancer is a highly lethal malignant tumor with a 5-year survival rate less than 8%.The prognosis of patients with pancreatic cancer who can undergo radical surgery is significantly different from that of those who have not undergone surgery.Simple surgical treatment can only increase the 5-year survival rate of pancreatic cancer to about 10%.The main reason is that the recurrence and metastasis rates are still extremely high after surgery alone,and the quality of patient life with recurrence and metastasis is poor,their prognosis is extremely poor,and the long-term survival time is short.Therefore,it is of great significance to seek more effective adjuvant therapy or regimen for pancreatic cancer surgery,and to carry out standardized,rational and comprehensive drug therapy,to control micrometastasis,and to prevent and delay recurrence.This research field is also the focus on research direction about pancreatic cancer in recent years.This article is based on the recent research and development of postoperative treatment of pancreatic cancer,exploring survival benefit of different drugs and different treatment options after pancreatic cancer surgery and the development trend of postoperative treatment of pancreatic cancer,providing a valuable reference for postoperative treatment of pancreatic cancer.

Key words: Postoperative adjuvant therapy, Pancreatic cancer, Chemo-therapy, Targeted therapy, Immuno-therapy

中图分类号:

R735.9

范晓娜, 王丹, 黎清炜, 李志伟. 胰腺癌术后辅助药物治疗的研究进展[J]. 实用肿瘤学杂志, 2020, 34(3): 249-253.

FAN Xiaona,WANG Dan,LI Qingwei,LI Zhiwei. Advances in research on adjuvant drug threapy for postoperative pancreatic cancer[J]. Journal of Practical Oncology, 2020, 34(3): 249-253.

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链接本文: http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/10.11904/j.issn.1002-3070.2020.03.011

http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/Y2020/V34/I3/249

参考文献

1 王鑫龙,孙备.中国抗癌协会胰腺癌综合诊治指南(2018版)更新解读[J].临床外科杂志,2019,27(1):21-24.
2 Wagner M,Redaelli C,Lietz M,et al.Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma[J].Br J Surg,2004,91(5):586-594.
3 Riediger H,Keck T,Wellner U,et al.The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer[J].J Gastrointest Surg,2009,13(7):1337-1344.
4 Kovaˇc JD,Mayer P,Hackert T,et al.The time to and type of pancreatic cancer recurrence after surgical resection:Is prediction possible?[J].Acad Radiol,2019,26(6):775-781.
5 Bakkevold KE,Arnesj B,Dahl O,et al.Adjuvant combination chemotherapy(AMF)following radical resection of carcinoma of the pancreas and papilla of vater-results of a controlled,prospective,randomised multicentre study[J].Eur J Cancer,1993,29(5):698-703.
6 Neoptolemos JP,Dunn JA,Stocken DD,et al.Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer:a randomised controlled trial[J].Lancet,2001,358(9293):1576-1585.
7 Oettle H,Neuhaus P,Hochhaus A,et al.Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer:the CONKO-001 randomized trial[J].JAMA,2013,310(14):1473-1481.
8 Ueno H,Kosuge T,Matsuyama Y,et al.A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer:Japanese study group of adjuvant therapy for pancreatic cancer[J].Eur J Cancer,2016,101(6):96-103.
9 Sudo K,Nakamura K,Yamaguchi T.S-1 in the treatment of pancreatic cancer[J].World J Gastroenterol,2014,20(41):15110-15118.
10 Yokoyama H,Nakanishi H,Kodera Y.Biological significance of isolated tumor cells and micrometastasis in lymph nodes evaluated using a green fuorescent protein tagged human gastric cancer cell line[J].Clin Cancer Res,2006,12(2):361-368.
11 Davendra PS.Adjuvant and neoadjuvant therapy for resectable pancreatic adenocarcinoma[J].Chin Clin Oncol,2017,6(3):26.
12 Ueno H,Kosuge T,Matsuyama Y,et al.A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer:Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer[J].Br J Cancer,2009,101(6):908-915.
13 Greenhalf W,Ghaneh P,Neoptolemos JP,et al.Pancreatic cancer hENT1 expression and survival from gemcitabine in patients from the ESPAC-3 trial[J].J Natl Cancer Inst,2014,106(1):347.
14 Valle JW,Palmer D,Jackson R,et al.Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas:ongoing lessons from the ESPAC-3 study[J].J Clin Oncol,2014,32(6):504-512.
15 Murakami Y,Uemura K,Hashimoto Y,et al.Survival effects of adjuvant gemcitabine plus S-1 chemotherapy on pancreatic carcinoma stratified by preoperative resectability status[J].J Surg Oncol,2016,113(4):405-412.
16 Xu JB,Jiang B,Chen Y,et al.Optimal adjuvant chemotherapy for resected pancreatic adenocarcinoma:a systematic review and network meta-analysis[J].Oncotarget,2017,8(46):81419-81429.
17 Kosuge T.A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer[J].Jpn J Clin Oncol,2006,36(3):159-165.
18 Postlewait LM,Ethun CG,Kooby DA,et al.Combination gemcitabine/cisplatin therapy and ERCC1 expression for resected pancreatic adenocarcinoma:results of a phase II prospective trial[J].J Surg Oncol,2016,114(3):336-341.
19 Khorana AA,McKenin SE,Berlin J,et al.Potentially curable pancreatic adenocarcinoma:ASCO clinical practice guideline update[J].J Clin Oncol,2019,37(23):2082-2088.
20 Antoniou G,Kountourakis P,Papadimitriou K,et al.Adjuvant therapy for resectable pancreatic adenocarcinoma:Review of the current treatment approaches and future directions[J].Cancer Treat Rev,2014,40(1):78-85.
21 Sinn M,Bahra M,Liersch T,et al.CONKO-005:Adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer:a multicenter randomized phase III Trial[J].J Clin Oncol,2017,35(29):3330-3337.
22 Shultz DB,Pai J,Chiu W,et al.A novel biomarker panel examining response to gemcitabine with or without Erlotinib for pancreatic cancer therapy in NCIC Clinical Trials Group PA.3[J].PLoS One,2016,11(1):e0147995.
23 Sinn M,Liersch T,Gellert K,et al.LBA18CONKO-006:a randomized double-blinded phase IIb-study of additive therapy with gemcitabine plus Sorafenib/Placebo for patients with R1-resection of pancreatic cancer[J].Ann Oncol,2014,25(suppl4):1-8.
24 Fenster H,Schade-Brittingger C,Muller HH,et al.Multicenter phase II trial to investigate safety and efficacy of gemcitabine combined with cetuximab as adjuvant therapy in pancreatic cancer(ATIP)[J].Ann Oncol,2013,24(10):2576-2581.
25 Sun D,Ma J,et al.Clinical observation of immune checkpoint inhibitors in the treatment of advanced pancreatic cancer:a real-world study in Chinese cohort[J].Ther Clin Risk Manag,2018,14:1691-1700.
26 Bahary N,Wang-Gillam A,Haraldsdottir S,et al.Phase 2 trial of the IDO pathway inhibitor indoximod plus gemcitabine/nab-paclitaxel for the treatment of patients with metastatic pancreas cancer[R].ASCO,2018.
27 Miyazawa M,Katsuda M,Maguchi H,et al.Phase II clinical trial using novel peptide cocktail vaccine as a postoperative adjuvant treatment for surgically resected pancreatic cancer patients[J].Int J Cancer,2017,140(4):973-982.
28 Lutz E,Yeo CJ,Lillemoe KD,et al.A lethally irradiated allogeneic granulocyte-macrophage colony stimulating factor-secreting tumor vaccine for pancreatic adenocarcinoma.A Phase II trial of safety,efficacy,and immune activation[J].Ann Surg,2011,253(2):328-335.
29 Hardacre JM,Mulcahy M,Small W,et al.Addition of algenpantucel-L immunotherapy to standard adjuvant therapy for pancreatic cancer:a phase 2 study[J].J Gastrointest Surg,2013,17(1):94-100.
30 Tsai S,Erickson BA,Dua K,et al.Evolution of the management of resectable pancreatic cancer[J].J Oncol Pract,2016,12(9):772-778.
31 Comito T,Cozzi L,Zerbi A,et al.Clinical results of stereotactic body radiotherapy(SBRT)in the treatment of isolated local recurrence of pancreatic cancer after R0 surgery:A retrospective study[J].Eur J Surg Oncol,2017,43(4):735-742.
32 Motoi F,Kosuge T,Ueno H,et al.Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer(Prep-02/JSAP05)[J].Jpn J Clin Oncol,2019,49(2):190-194.

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