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Gemzar有助於對抗胰臟癌

  June 4, 2008 (芝加哥) 研究人員表示,對於某些因罹患胰臟癌而接受手術的病人來說,手術後服用癌症藥物Gemzar可以加倍存活機會。

  德拉瓦州威明頓市Helen F. Graham癌症中心醫學主任Nicholas Petrelli醫學博士表示,壞消息是,在高達80%的病患中,胰臟癌初期症狀並不明顯,通常在癌症擴散到胰臟以外的部位才發現,此時,已經無法以外科手術治療。

  他表示,或許仍有早期疾病階段病患,只能接受手術的環境,這些研究發現將會改變這樣的狀況;我們實際上可以告訴他們,Gemzar將會增加他們的存活機會。

  Petrelli主持大眾媒體的簡報,研究發現發表於美國臨床腫瘤學協會的年會上。研究人員柏林Charite大學醫學學校Helmut Oettle醫學博士表示,Gemzar應該成為胰臟病患治療(術後)的照護標準。

  【用Gemzar治療胰臟癌】

  根據美國癌症協會表示,在美國,預估將有37,680人在2008年被診斷出罹患胰臟癌,大約34,290人會死於此疾病,使它成為第四致命的癌症。

  Gemzar是那些無法以外科手術進行治療之胰臟癌患者的標準療法。

  這項新研究包括超過300名病患,這些人曾接受治療胰臟癌的外科手術;半數的人在手術後服用Gemzar治療六個月,其他人則被密切觀察是否有腫瘤復發跡象,並未接受特定的抗癌治療。

  在第三年時,服用Gemzar的參加者中有76%的人癌症復發,而未服用此藥的病患,癌症復發的有92%;在第五年時,服用與未服用Gemzar的患者,復發率分別是84%94%。服用Gemzar的人中,21%在五年之後仍然存活,而未服用此種藥物者,仍存活者僅9%;換句話說,服用Gemzar的病患中有一半的人在診斷之後22.8個月仍活著,至於觀察組則約存活20.2個月。

  其他研究目前正在進行中,以確定 TarcevaNexavarGemzar等標靶治療,是否能更進一步增進某些胰臟病患手術後的存活率。

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Pancreatic Cancer Treatment (PDQ®)

There are different types of treatment for patients with pancreatic cancer.

Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

One of the following types of surgery may be used to take out the tumor:

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:

  • Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
  • Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

There are treatments for pain caused by pancreatic cancer.

Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.

Patients with pancreatic cancer have special nutritional needs.

Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Related Pages :

National Cancer InstituteClinical TrialsClinical Trial Results

胰腺癌 - 摘錄自維基百科全書

胰腺癌

Pancreatic cancer
分類系統及外部資源
ICD-10C25.
ICD-9157
OMIM260350
DiseasesDB9510
MedlinePlus000236
eMedicinemed/1712
MeSHD010190

胰腺癌胰臟出現的癌症,其惡性腫瘤會在患者的胰臟生長。



胰臟癌概觀

根據世界衛生組織(WHO)估計,胰臟癌在全世界發生率排名第十三個,在所有癌症死亡率排名第八,在2002年統計中全世界大約將近227,000位病人死於這一種高度惡性的疾病,其發病的速度與現行缺乏有效的療法,讓其發生率與死亡率幾乎相同。 胰臟癌在先進西方國家的流行率,約每十萬人有七到十人,去年2006年美國大約有32,000位,歐洲地區大約有60,000位病人罹患。在台灣地區,胰臟癌名列九十五年度癌症死亡原因第十位,約有一千兩百人死於胰臟癌,每十萬人口死亡率為5.5%;在中國大陸,胰腺癌也是造成人口死亡的十大惡性腫瘤之一,而且患者增加速度很快,並且有年輕化的趨勢:北京協和醫院近年來收住院的胰腺癌病人比50年代增加了5~6倍,並且據北京地區7家醫院354例病例分析,病人中41~70歲者佔80%。
胰臟癌是一個高度惡性的疾病,約90%的病人無法以手術根除治療,整體而言,五年的存活率低於5%。病理上胰臟癌的病人大約90%以上都是屬於腺癌(adenocarcinomas) ,臨床表現症狀則是上腹疼痛、體重減輕、進行性的黃疸(佔50%)。大部份診斷出胰臟癌的病人被發現時都已經是進行性疾病來呈現,統計發現只有10% 的病人能進行手術,絕大多數的病人發現時已經是局部侵襲性疾病或已發生轉移。 治療的目標通常是緩解症狀(palliative),治癒(cure)幾乎是不可能,緩和的化學療法目的是能提高存活率或末期生活品質。

體征和癥狀

早期胰腺癌通常沒有明顯的癥狀,之後也缺乏顯著或者確定的癥狀。通常來說胰腺癌患者具有以下癥狀:

  • 上腹部疼痛,並通常蔓延至背部疼痛,並且此疼痛在身體前傾時能得到減輕
  • 無食慾,或者是噁心嘔吐
  • 體重明顯減輕
  • 與膽管梗阻相關的無痛黃疸

所有這些癥狀都對應有其他多種病因,因此胰腺癌經常到晚期才能夠被確診。

發病風險

這種癌病的發病風險視乎以下的因素而定。


目前藥物治療選擇

傳統的化學治療對於胰臟癌的控制並無太大的幫助。過去常用的藥物5-Fluorouracil(5-FU),但其反應率很少超過25%。 目前侵襲性胰臟癌的第一線標準治療是使用單一藥物Gemcitabine,建議劑量是1000 mg/m2。 gemcitabine並無特別突出的反應率也不能根治胰臟癌,gemcitabine的主要影響只在於改善生活品質,顯示出它低毒性的特點及減輕疼痛,稍稍延長存活期。 目前,因為對胰臟癌並沒有真正有效的抗癌藥品可供使用,而Gemcitabine在1998年被美國食品藥物管理局 (FDA)第一個核准用於治療胰臟癌的抗癌藥品。
在2005年11月美國食品藥物管理局(FDA)核准使用標靶藥物Erlotinib (Tarceva)與gemcitabine合併治療晚期胰臟癌第一線使用,雖然在存活期及反應率比較統計上有意義,但是臨床治療上並不能發現其帶來的明顯好處。 最近幾年,從一些重要臨床試驗發現gemcitabine與其他合併療法的藥物,並無法有意義證明其好處,包括在今年2007 ASCO meeting 最近所發表合併使用bevacizumab及cetuximab,都無法看到其治療好處。此外,今年2007 ASCO meeting 也發表兩項重要臨床研究,試圖找出除了gemcitabine以外合併療法第一線使用的藥物,包括irinotecan/docetaxel 及 FOLFIRINOX (5- fU/leucovorin,irinotecan and oxaliplatin) 。 至於第二線使用的藥物,更是缺乏有意義的結果及改善末期的生活品質。
  • 無有效治療的平均生存期3個月,做過膽繞道手術的是7個月,手術過的大約16個月,女性長過男性。

摘錄自維基百科,自由的百科全書

Gemcitabine