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Combining epidermal growth factor receptor inhibitors and radiation therapy in pancreatic cancer: small step or giant leap?

JOP: Journal of the pancreas 02/2009; 10(3):231-6.
Source: PubMed

ABSTRACT Targeting the epidermal growth factor receptor (EGFR) with small molecule inhibitors or monoclonal antibodies in combination with chemotherapy and radiation is a theoretically appealing strategy in pancreatic cancer. EGFR inhibitors have shown efficacy as radiosensitizers and activity against metastatic pancreatic cancer when combined with gemcitabine. This paper examines the available clinical data, with a focus on locally advanced, unresectable disease. Further studies with a focus on understanding the basic biology of EGFR inhibition are needed to identify an optimal multi-modality regimen.

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    ABSTRACT: ObjectiveThe aim of our study was to evaluate the efficacy and safety of gefitinib combined with γ-ray stereotactic radiotherapy for senile patients with adenocarcinoma of lung as the first-line regimen. MethodsThe 153 senile patients with adenocarcinoma of lung were divided into 4 groups according to the therapy method. Group A was the 35 patients treated with gefitinib combined with γ-ray stereotactic radiotherapy. Group B was the 45 patients treated with γ-ray stereotactic radiotherapy. Group C was the 42 patients treated with gefitinib. Group D was the 31 patients treated with best supportive therapy. The patients received gefitinib of 250 mg/d from the first day until disease progression or other reasons. The patients were treated with γ-ray stereotactic radiotherapy from the second day. Dose curve of this group of cases was 50%–80%. Encircled dose was 4.0–6.5 Gy per fraction and the range of total dose was 36–48 Gy. The total number of treatment was 8–12 and treated six times every week. ResultsAll the patients were examined by enhanced double helix CT at the second month. The tumor response rate (RR) of group A was 68.6% (24/35). Disease control rate (DCR) was 88.6% (31/35). The median survival time (MST) was 13.4 months (range 3–34 months) and the progression-free survival (PFS) was 7.8 months. The overall 1-year survival rate was 40.0% (14/35). The main side effects included skin rash and diarrhea. The RR of group B was 51.1% (23/45). DCR was 71.1% (32/45). MST was 9.6 months (range, 3–18 months) and PFS was 5.3 months. The overall 1-year survival rate was 15.6 % (7/45). The RR of group C was 40.5 % (17/42). DCR was 61.9% (26 /42). MST was 10.3 months (range, 3–26 months) and PFS was 5.1 months. The overall 1-year survival rate was 35.7 % (15/42). The main side effects included skin rash and diarrhea. The MST of group D was 5.6 months (range, 2–11 months) and PFS was 1.7 months. The overall 1-year survival rate was 0. The short-term therapeutic effects (RR) of group A was higher than group C (P = 0.014 < 0.05, χ2 = 6.053) but has no significant difference with group B (P = 0.116 > 0.05, χ2 = 2.477). The long-term therapeutic effects (overall 1-year survival rate) of group A was higher than group B (P = 0.014 < 0.05, χ2 = 6.077) but has no significant difference with group C (P = 0.642 > 0.05, χ2 = 0.216). ConclusionGefitinib combined with γ-ray stereotactic radiotherapy is feasible and effective for treatment in senile patients with adenocarcinoma of lung as the first-line regimen. Key wordsgefitinib–γ-ray stereotactic radiotherapy–adenocarcinoma of lung–senile–first-line regimen
    The Chinese-German Journal of Clinical Oncology 07/2011; 10(7):386-390. DOI:10.1007/s10330-011-0802-y
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    ABSTRACT: Pancreatic cancer remains associated with an extremely poor prognosis. Surgical resection can be curative, but the majority of patients present with locally advanced or metastatic disease. Treatment for patients with locally advanced disease is controversial. Therapeutic options include systemic therapy alone, concurrent chemoradiation, or induction chemotherapy followed by chemoradiation. We review the evidence to date regarding the treatment of locally advanced pancreatic cancer (LAPC), as well as evolving strategies including the emerging role of targeted therapies. We propose that if radiation is used for patients with LAPC, it should be delivered with concurrent chemotherapy and following a period of induction chemotherapy.
    International journal of radiation oncology, biology, physics 11/2011; 82(2):508-18. DOI:10.1016/j.ijrobp.2011.08.008 · 4.59 Impact Factor
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    ABSTRACT: Lung cancer is one of the most commonly encountered human malignancies. Due to the increase in life expectancy as well as the incidence of lung cancer, the incidence of senile lung cancer has increased significantly. We conducted a study to evaluate the efficacy and safety of gefitinib combined with γ-ray stereotactic body radiation therapy (SBRT) as the first-line treatment regimen for senile patients with adenocarcinoma of the lung. A total of 122 senile patients with adenocarcinoma of the lung were divided into 3 groups according to the treatment method. Group A included 35 patients treated with gefitinib combined with γ-ray SBRT, group B included 45 patients treated with γ-ray SBRT alone and group C included 42 patients treated with gefitinib alone. The patients received 250 mg of gefitinib per day, from the first day of the treatment until disease progression or discontinuation due to other causes. The patients were treated with γ-ray SBRT, initiated on the second day. The dose curve for this case group was 50-80%. The encircled dose was 4.0-6.5 Gy per fraction and the range of the total radiation dose was 36-48 Gy. The total number of treatments was 8-12, at a frequency of 5 times per week. All 122 patients were assessed by contrast-enhanced double helical computed tomography (CT) at 2 months. The tumor response rate (RR) of group A was 68.6% (24/35), the disease control rate (DCR) was 88.6% (31/35), the median overall survival (OS) was 15.5 months (range, 3-52 months) and the progression-free survival (PFS) was 7.8 months. The 1-year OS rate was 40.0% (14/35). The main side effects included skin rash and diarrhea. The RR of group B was 51.1% (23/45), the DCR was 71.1% (32/45), the OS was 9.6 months (range, 3-22 months) and the PFS was 5.3 months. The 1-year OS rate was 15.6% (7/45). The RR of group C was 40.5% (17/42), the DCR was 61.9% (26/42), the OS was 10.3 months (range, 3-26 months) and the PFS was 5.1 months. The 1-year OS rate was 35.7% (15/42). The main side effects included skin rash and diarrhea. The short-term therapeutic effect (RR) in group A was higher compared to that in group C (P=0.014, χ(2)=6.053); however, there was no significant difference compared to group B (P=0.116, χ(2)=2.477). The PFS of group A was higher compared with that of groups B and C (7.8 vs. 5.9, P=0.018 and 7.8 vs. 5.1, P=0.013, respectively). The OS of group A was higher compared with that of groups B and C (15.5 vs. 9.6, P=0.002 and 15.5 vs. 10.3, P=0.017, respectively). No significant differences were observed in PFS and OS between groups B and C. In conclusion, gefitinib combined with γ-ray SBRT appears to be feasible and effective as the first-line treatment in senile patients with adenocarcinoma of the lungs.
    Molecular and Clinical Oncology 07/2013; 1(4):711-715. DOI:10.3892/mco.2013.135

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