晚期胰臟癌全身性治療之新發展

Recent Advances in Systemic Therapy for Advanced Pancreatic Cancer

楊士弘(Shih-Hung Yang) ； 廖偉智(Wei-Chih Liao) ； 田郁文(Yu-Wen Tien) ； 葉坤輝(Kun-Huei Yeh)

《台灣醫學》 21卷4期 (2017/07) Pp. 386-393

https://doi.org/10.6320/FJM.2017.21(4).7

摘要

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。

關鍵字

胰臟癌 ； gemcitabine ； nab-paclitaxel ； FOLFIRINOX ； nanoliposomal irinotecan

並列摘要

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.

並列關鍵字

pancreatic cancer ； gemcitabine ； nab-paclitaxel ； FOLFIRINOX ； nanoliposomal irinotecan