Pancreatic cancer: is this bleak landscape finally changing? Highlights from the '43rd ASCO Annual Meeting'. Chicago, IL, USA. June 1-5, 2007.

Pancreatic cancer remains a major therapeutic challenge in 2007. Most patients with advanced pancreatic cancer experience pain and must limit their daily activities because of tumor-related symptoms. Single-agent gemcitabine remains the standard treatment for advanced pancreatic cancer , which has shown improvement in disease-related symptoms and a modest benefit in survival. Recent phase III trials using gemcitabine in combination with other chemotherapeutic agents have failed to show improvements in survival, although the gemcitabine/oxaliplatin and gemcitabine/capecitabine combinations have shown some promise. The combination of gemcitabine with erlotinib, though showed a statistically significant prolongation of survival, may not be clinically significant. Encouraging results in two separate phase II trials of gemcitabine in combination with bevacizumab and cetuximab respectively led to two major randomized comparative trials of the combination (Cancer and Leukemia Group B, CALGB 80303; Southwest Oncology Group, SWOG S0205). The results of these studies presented at the 43rd American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, USA (June 1-5, 2007) showed no benefit of the combination. 'How can we change this bleak landscape?'. Probably by truly targeting our therapy with the epidermal growth factor receptor (EGFR) agents as well as other biologic agents by identifying those patients who are most likely to derive benefit and achieve meaningful responses. This is particularly crucial in a disease such as pancreatic cancer that has such a short life expectancy that the 'window' for any given treatment may be quite small. Consequently, further study should include the development of more predictive assays and improved exploitation of surrogate biomarkers of response. We need to study locally advanced pancreatic cancer patients separate from advanced pancreatic cancer patients. Role of multiple-targeted agents is also warranted. It's also time to investigate gemcitabine-free regimens. Two recent studies presented at ASCO showed that irinotecan/docetaxel or FOLFIRINOX (5-fluorouracil/leucovorin, irinotecan and oxaliplatin) can offer comparable results to gemcitabine when used as first-line treatment for advanced pancreatic cancer. Development of novel agents and approaches, are urgently needed in conjunction with improvement in access to clinical trials for patients.