Drug of choice for palliative treatment of pancreatic carcinoma

Ans. is 'b > a & c' i.e. Gemcitabin > Erlotinib & Paclitaxel Treatment for Inoperable pancreatic cancerA) Inoperable locally advanced disease* Approximately 30% of patients present with locally advanced unresectable but nonmetastatic pancreatic carcinoma.* Gemcitabine is used a the treatment of choice for these patients.* The median survival with gemcitabine is 9 months, and patients who respond to or achieve stable disease after 3-6 months of gemcitabine may derive benefit from consolidation radiotherapy.B) Metastatic Disease* Approximately 60% of patients with pancreatic cancer present with metastatic disease.* Gemcitabine is the standard treatment with a median survival of 6 months and a 1-year survival rate of only 20%.* The combination of erlotinib, oral HER1/EGFR tyrosine kinase inhibitor with gemcitabine resulted in an improved 1-year survival compared with gemcitabine alone (23% versus 17%, p = 0.023).* Capecitabine, an oral fluoropyrimidine, has been combined with gemcitabine (GEM-CAP) in a phase III trial that showed an improvement in response rate and progression-free survival over single-agent gemcitabine, but no survival benefit.* A trial in good performance status patients with metastatic pancreatic cancer showed improved survival with the combination of 5FU/FA, irinotecan and oxaliplatin (FOLFIRINOX) compared with gemcitabine, but with increased toxicity. Nab-paclitaxel (Abraxane), an albumin bound nano-particle formulation of paclitaxel, given with gemcitabine also shows promising activity.