篇名 | 晚期胰臟癌全身性治療之新發展 |
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卷期 | 21:4 |
並列篇名 | Recent Advances in Systemic Therapy for Advanced Pancreatic Cancer |
作者 | 楊士弘 、 廖偉智 、 田郁文 、 葉坤輝 |
頁次 | 386-393 |
關鍵字 | pancreatic cancer 、 gemcitabine 、 nab-paclitaxel 、 FOLFIRINOX 、 nanoliposomal irinotecan 、 胰臟癌 、 TSCI |
出刊日期 | 201707 |
DOI | 10.6320/FJM.2017.21(4).7 |
大部分胰臟癌的病患在診斷時已經處在晚期,預後不佳。在gemcitabine成為標準治療之前,化學 治療的存活時間有限,且具明顯血液及腸胃道副作用。在gemcitabine成為標準第一線治療之後, gemcitabine與多種藥物併用的臨床試驗皆未能進一步提升成果。Gemcitabine與erlotinib併用雖然能夠極 小幅延長整體存活期,但實質臨床益處有限,且副作用增加。然而,gemcitabine與nab-paclitacxel併用, 或是FOLFIRINOX,為一不含gemcitabine的複合性化療處方,雖然增加毒性,但卻比gemcitabine單獨 使用又能更進一步改善病患整體存活期。此外,口服S-1與gemcitabine被證實療效相當。在gemcitabine 為基礎的治療失效之後,nanoliposomal irinotecan併用5-FU/folic acid能夠延長整體存活期,成為標準治 療。而以oxaliplatin併用5-FU/folic acid的治療是否能能夠延長整體存活期仍有爭議。至於發展中的各種 免疫治療藥劑,目前已知的療效有限,未來仍需更多研究。
The majority of patients with pancreatic cancer are in advanced stages at diagnosis. The prognosis is dismal. The overall survival (OS) after chemotherapy in the pre-gemcitabine era is limited. The hematological and gastrointestinal toxicities of chemotherapy are significant. After gemcitabine becoming the standard first-line chemotherapy, most trials of gemcitabine-based combinational regimens failed. Gemcitabine plus erlotinib demonstrated the limited benefit in OS with increased toxicities. However, even with increased toxicities, gemcitabine plus nab-paclitaxel, or FOLFIRINOX – a non-gemcitabine-containing regimen, significantly improved the OS comparing with gemcitabine alone. In addition, S-1 and gemcitabine were demonstrated to have a comparable efficacy. After failure with gemcitabine-based regimens, nanoliposomal irinotecan plus 5-FU and folic acid become the standard therapy as the OS benefits proved. Regarding oxaliplatin plus 5-FU and folic acid, it is still controversial to have OS benefits. More studies are required to prove the efficacy of immunotherapy because the evidence to support its usage is limited.