| セッション情報 | パネルディスカッション15(消化器外科学会・消化器病学会・消化器内視鏡学会合同)進行膵癌に対する集学的治療の標準化に向けて |
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| タイトル | PD15-基調講演2：Neoadjuvant Treatment for Patients With Localized Pancreatic Adenocarcinoma |
| 演者 | P. W. T. Pisters（MD Anderson Cancer Center） |
| 共同演者 | |
| 抄録 | For patients with operable pancreatic cancer, who account for only 10 to 15% of new cases, the only known curative treatment is surgical resection of the primary tumor. However, most patients, including those who undergo primary complete primary tumor resection (R0) and have negative lymph nodes experience systemic disease recurrence within three years of surgery. Indeed studies with long-term follow-up indicate that only 10 to 15% of surgically treated patients survive 5 years. Preoperative treatment for patients with operable pancreatic cancer offers a number of potential advantages including early treatment of micrometastatic disease, improved delivery of chemotherapy, and improved patient selection for surgery since patients with rapidly progressive disease are spared unnecessary surgical treatment. To date, no randomized trial has evaluated preoperative chemotherapy treatment. However there remains considerable interest in preoperative treatment given the high frequency of occult metastatic disease in patients presenting with ostensibly localized pancreatic adenocarcinoma, the theoretical advantages of preoperative treatment, and the considerable experience of preoperative chemotherapy treatment for other solid tumors. For more than 15 years, the University of Texas M. D. Anderson Cancer Center Pancreatic Tumor Study Group has maintained a research focus on neoadjuvant treatment for patients with localized disease. This has resulted in a number of significant advances including demonstration of achievable median survivals of 35 months for patients treated with preoperative chemoradiation followed by surgery. Long-term outcome data from our center demonstrate a 5-year actual survival rate of 27% and a 10-year actual survival rate of 14% for patients treated with preoperative combined-modality treatment in our clinical experience. Thus, these data provide substantial evidence to support this paradigm in the context of the standard median survival of 10 to 18 months that is seen in patients treated by surgery alone. Most recently, preoperative treatment has moved on to the national stage in the United States with the opening of the American College of Surgeons Oncology Group trial Z5041. This phase II study evaluates preoperative gemcitabine and erlotinib chemotherapy followed by surgery and postoperative gemcitabine and erlotinib for patients with localized pancreatic cancer. The primary endpoint is 2-year overall survival with a targeted sample size that has increased to 125 patients. Indeed, this will be the first study performed to date that will include protocol specified surgery quality control and pathology assessment. Correlative science studies are planned evaluating EGFR biology in the context of preoperative erlotinib administration and resection of the harvested tumor that will be banked centrally and subsequently analyzed in robust correlative science studies that are dovetailed with this important clinical trial. In summary, preoperative treatment remains a very compelling therapeutic approach for a disease that is systemic at diagnosis in the majority of patients. In this context induction chemotherapy provides a very rationale approach for this high-risk patient population with very promising results reported in our clinical experience. |
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