内容紹介
Chemoradiotherapy for Locally Advanced Pancreatic Cancer
Summary
The use of FOLFIRINOX and gemcitabine plus nab-paclitaxel for unresectable pancreatic cancer is currently approved in Japan. Although the efficacies of these regimens were investigated only in patients with metastatic pancreatic cancer, they are also expected to be effective for locally advanced pancreatic cancer. Meanwhile, chemoradiotherapy is recognized as a treatment option for locally advanced pancreatic cancer. S-1 or capecitabine-based chemoradiotherapy is being developed in Japan or in Western countries, respectively. Recently, the concept of induction chemotherapy followed by chemoradiotherapy has been accepted and applied in clinical trials. In the JCOG1106 trial, induction gemcitabine followed by S-1 and concurrent radiotherapy demonstrated promising results. This regimen has been recognized as a very promising one for chemoradiotherapy in Japan. However, the optimal therapy for locally advanced pancreatic cancer remains controversial, especially in terms of which between chemotherapy and chemoradiotherapy is superior.
要旨
切除不能膵癌に対する治療は,日本でもFOLFIRINOX療法やgemcitabine+nab-paclitaxel療法が選択可能となった。これらの治療法の有効性は転移例のみで証明されているが,局所進行膵癌に対しても期待されている。一方で,局所進行膵癌の治療は化学放射線療法も選択肢の一つであり,日本ではS-1併用,欧米ではcapecitabine併用の化学放射線療法が行われてきている。さらに,最近では導入化学療法の概念が生まれ開発が進んでいる。JCOG1106試験において,gemcitabineによる導入化学療法後のS-1併用化学放射線療法の有効性が確認され,日本での化学放射線療法のbest regimenが確立されつつある。しかし,依然として化学療法がよいのか化学放射線療法がよいのか,一定の見解は得られていない。本稿では局所進行膵癌に対する化学放射線療法に関して解説する。
目次
Summary
The use of FOLFIRINOX and gemcitabine plus nab-paclitaxel for unresectable pancreatic cancer is currently approved in Japan. Although the efficacies of these regimens were investigated only in patients with metastatic pancreatic cancer, they are also expected to be effective for locally advanced pancreatic cancer. Meanwhile, chemoradiotherapy is recognized as a treatment option for locally advanced pancreatic cancer. S-1 or capecitabine-based chemoradiotherapy is being developed in Japan or in Western countries, respectively. Recently, the concept of induction chemotherapy followed by chemoradiotherapy has been accepted and applied in clinical trials. In the JCOG1106 trial, induction gemcitabine followed by S-1 and concurrent radiotherapy demonstrated promising results. This regimen has been recognized as a very promising one for chemoradiotherapy in Japan. However, the optimal therapy for locally advanced pancreatic cancer remains controversial, especially in terms of which between chemotherapy and chemoradiotherapy is superior.
要旨
切除不能膵癌に対する治療は,日本でもFOLFIRINOX療法やgemcitabine+nab-paclitaxel療法が選択可能となった。これらの治療法の有効性は転移例のみで証明されているが,局所進行膵癌に対しても期待されている。一方で,局所進行膵癌の治療は化学放射線療法も選択肢の一つであり,日本ではS-1併用,欧米ではcapecitabine併用の化学放射線療法が行われてきている。さらに,最近では導入化学療法の概念が生まれ開発が進んでいる。JCOG1106試験において,gemcitabineによる導入化学療法後のS-1併用化学放射線療法の有効性が確認され,日本での化学放射線療法のbest regimenが確立されつつある。しかし,依然として化学療法がよいのか化学放射線療法がよいのか,一定の見解は得られていない。本稿では局所進行膵癌に対する化学放射線療法に関して解説する。