晚期胰臟癌全身性治療之新發展

Recent Advances in Systemic Therapy for Advanced Pancreatic Cancer

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-l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.