134 | La Lettre de l’Hépato-gastroentérologue • Vol. XII - n° 4 - juillet-août 2009
Cancer du pancréas exocrine
DOSSIER THÉMATIQUE
Journée FFCD-PRODIGE
Conclusion
L’efficacité de la gemcitabine est confirmée en
chimiothérapie adjuvante après chirurgie d’exé-
rèse. Plusieurs études rétrospectives (portant sur
des périodes antérieures à l’ère de la gemcitabine)
suggèrent un bénéfi ce à une radio-chimiothérapie
postopératoire, traitement à valider dans un essai
prospectif randomisé. L’effet bénéfi que des traite-
ments adjuvants est constaté quel que soit l’état
des marges. Le CA 19-9 postopératoire a une valeur
pronostique, mais ne permet pas d’apprécier l’effi ca-
cité d’une chimiothérapie palliative. La gemcitabine
seule reste le standard pour les cancers du pancréas
métastatiques, et aucune molécule nouvelle n’a été
validée en phase III en 2008. ■
1. Hassan MM, Li D, El-Deeb AS et al. Association between
hepatitis B virus and pancreatic cancer. J Clin Oncol 2008;
26:4557-62.
2. Pannala R, Leirness JB, Bamlet WR et al. Prevalence and
clinical profi le of pancreatic cancer-associated diabetes
mellitus. Gastroenterology 2008;134:981-7.
3. Doi R, Imamura M, Hosotani R et al. Surgery versus radio-
chemotherapy for resectable locally invasive pancreatic
cancer: fi nal results of a randomized multi-institutional
trial. Surg Today 2008;38:1021-8.
4. Diener MK, Heukaufer C, Schwarzer G et al. Pancreatico-
duodenectomy (classic Whipple) versus pylorus-preserving
pancreaticoduodenectomy (pp Whipple) for surgical treat-
ment of periampullary and pancreatic carcinoma. Cochrane
Database Syst Rev 2008:CD006053.
5. Slidell MB, Chang DC, Cameron JL et al. Impact of total
lymph node count and lymph node ratio on staging and
survival after pancreatectomy for pancreatic adenocarci-
noma: a large, population-based analysis. Ann Surg Oncol
2008;15:165-74.
6. Berger AC, Garcia M Jr, Hoffmann JP et al. Postresection
CA 19-9 predicts overall survival in patients with pancreatic
cancer treated with adjuvant chemoradiation: a prospec-
tive validation by RTOG 9704. J Clin Oncol 2008;26:
5918-22.
7. Hernandez JM, Cowgill SM, Al-Saadi S et al. CA 19-9
velocity predicts disease-free survival and overall survival
after pancreatectomy of curative intent. J Gastrointest Surg
2009;13:349-53.
8. Stessin AM, Meyer JE, Sherr DL. Neoadjuvant radiation in
association with improved survival in patients with resectable
pancreatic cancer: an analysis of data from the Surveillance,
Epidemiology, and End Results (SEER) registry. Int J Radiat
Oncol Biol Phys 2008;72:1128-33.
9. Neuhaus P, Riess H, Post S et al. CONKO-001: Final results
of the randomized, prospective, multicenter phase III trial of
adjuvant chemotherapy with gemcitabine versus observation
in patients with resected pancreatic cancer (PC). J Clin Oncol
2008;26(Suppl.): abstract LBA 4504.
10. Regine WF, Winter KA, Abrams RA et al. Fluorouracil vs
gemcitabine chemotherapy before and after fl uorouracil-
based chemoradiation following resection of pancreatic
adenocarcinoma. A randomized controlled trial. JAMA 2008;
299:1019-26.
11. Corsini MM, Miller RC, Haddock MG et al. Adjuvant radio-
therapy and chemotherapy for pancreatic carcinoma: the
Mayo Clinic experience (1975-2005). J Clin Oncol 2008;
26:3511-6.
12. Herman JM, Swartz MJ, Hsu CC et al. Analysis of fl uo-
rouracil-based adjuvant chemotherapy and radiation after
pancreaticoduodenectomy for ductal adenocarcinoma of
the pancreas: results of a large prospectively collected
database at the Johns Hopkins Hospital. J Clin Oncol 2008;
26:3503-10.
13. Chauffert B, Mornex F, Bonnetain F et al. Phase III
trial comparing intensive induction chemoradiotherapy
(60 Gy, infusional 5-FU and intermittent cisplatin) followed
by maintenance gemcitabine with gemcitabine alone for
locally advanced unresectable pancreatic cancer. Defi ni-
tive results of the 2000-01 FFCD/SFRO study. Ann Oncol
2008;19:1592-9.
14. Azria D, Seblain-El-Guerche C, Girard N et al. Intérêt de
la chimioradiothérapie dans la prise en charge des adéno-
carcinomes du pancréas localement avancés : revue systé-
matique. Bull Cancer 2008;95:1116-30.
15. Spano JP, Chodkiewicz C, Maurel J et al. Efficacy of
gemcitabine plus axitinib compared with gemcitabine alone
in patients with advanced pancreatic cancer: an open-label
randomised phase II study. Lancet 2008;371:2101-8.
16. Eckhardt SG, De Porre P, Smith D et al. Patient-reported
outcomes as a component of the primary endpoint in a double-
blind, placebo-controlled trial in advanced pancreatic cancer.
J Pain Symptom Manage 2009;37:135-43.
17. Heinemann V, Boeck S, Hinke A et al. Meta-analysis of
randomized trials: evaluation of benefi t from gemcitabine-
based combination chemotherapy applied in advanced
pancreatic cancer. BMC Cancer 2008;8:82.
18. Bernhard J, Dietrich D, Scheithauer W et al. Clinical
benefit and quality of life in patients with advanced
pancreatic cancer receiving gemcitabine plus capecita-
bine versus gemcitabine alone: a randomized multicenter
phase III clinical trial-SAKK 44/00-CECOG/PAN.1.3.001.
J Clin Oncol 2008;26:3695-701.
19. Hess V, Glimelius B, Grawe P et al. CA 19.9 tumour-
marker response to chemotherapy in patients with advanced
pancreatic cancer enrolled in a randomised controlled trial.
Lancet Oncol 2008;9:132-8.
Références bibliographiques
Abonnez-vous en ligne !
Bulletin d’abonnement
disponible page 147
www.edimark.fr