Until recently, 5-Fluorouracil (5-FU) monochemotherapy had to be considered the standard in advanced pancreatic carcinoma although neither remission rates nor increases in median survival time have been convincing. Various efforts have been taken to improve the efficacy of 5-FU Polychemotherapeutic regimens with 5-FU as well as biomodulation of 5-FU could not ameliorate the results. In recent years, new drugs like the taxanes. topoisomerase inhibitors, and gemcitabine focused attention in chemo-therapeutic regimens. However, in a purely palliative situation as it is the case for pancreatic carcinoma a shift between drug toxicity and therapeutic symptom relief to the latter side is warranted. This gave way to the development of a new measure for therapy efficacy which aims at analyzing the patients’ well-being. This so-called ‘clinical benefit response’ (CBR) comprises quality of life parameters as pain intensity and analgesic consumption, Karnofsky’s performance index and weight changes. In a pro-spectively randomised study, gemcitabine showed a significantly better CBR than 5-FU and a good response rate, too. However, further trials are necessary to confirm these results. A definite statement of the relative roles of either chemotherapy or radiation in combined modality regimens cannot be given as yet. There are no convincing data that the combination of these two strategies will result in any additive or synergistic profit for the patient concerning symptom relief or even survival time. On the other hand, hormonal therapy modalities as for instance tamoxifen and/or somatostatin may be useful tools with the advantage of only minor toxicity. Nevertheless, even as new drugs have entered the treatment of pancreatic carcinoma, survival figures have not very much improved. Palliation strategies should be stressed further in clinical trials especially since the advent of CBR as a new objective.

Keywords:
Pancreatic carcinoma, Chemotherapy, Radio-chemotherapy, Hormone therapy, Clinical benefit response
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© 1996 S. Karger AG, Basel
1996
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