目前转移性和不可切除胰腺癌的全身治疗方案

C. Caglevic, M. Mahave, C. Sanhueza, L. Ubillos
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引用次数: 1

摘要

转移性和局部晚期不可切除的胰腺癌是一种致命的疾病,预后很差,很少有例外。目前,主要的治疗方法是细胞毒性化疗加最佳支持治疗。对于表现良好的患者,一线治疗包括FOLFIRINOX或吉西他滨加nab-紫杉醇方案。携带有害种系BRCA突变的患者可以在FOLFIRINOX后使用维持性奥拉帕尼治疗。对于表现不佳但仍适合化疗的患者,可采用单药吉西他滨治疗。二线治疗将取决于以前的治疗和目前的表现状态。以吉西他滨为基础的方案治疗的患者的选择是5-氟尿嘧啶加亚叶酸钙加纳米脂质体伊立替康、伊立替康或奥沙利铂。接受一线FOLFIRINOX治疗的患者可能受益于基于吉西他滨的化疗,但缺乏随机试验的证据。其他选择,如免疫疗法和靶向治疗,只有在非常特定的病例中才会产生效果,而且这仍然是一个研究领域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current Systemic Treatment Options for Metastatic and Unresectable Pancreatic Cancer
Metastatic and local advanced unresectable pancreatic cancers are lethal conditions that always carry a poor prognosis with rare exceptions. Currently, the mainstay of therapy is cytotoxic chemotherapy plus best supportive care. First-line therapy for patients with a good performance status includes FOLFIRINOX or gemcitabine plus nab-paclitaxel regimens. Patients carrying a deleterious germline BRCA mutation can be treated with maintenance olaparib after FOLFIRINOX. Patients with a poor performance status, but still fit enough for chemotherapy, may be treated with single agent gemcitabine. Second-line therapy will depend on previous therapy and current performance status. Options for patients treated with gemcitabine-based regimens are 5-fluorouracil plus leucovorin plus either nanoliposomal irinotecan, irinotecan or oxaliplatin. Patients that were treated with first line FOLFIRINOX may benefit from a gemcitabine-based chemotherapy, but evidence from randomized trials is lacking. Other options like immunotherapy and targeted therapies yield benefit only in very selected cases, and it is still an area of research.
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