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Locally Advanced Unresectable Cancer

Locally advanced unresectable Cancer

Combination chemotherapy without radiation is the preferred choice therapy. I would continue combination chemotherapy as long as the following parameters were met:

  1. It is well tolerated
  2. The CA 19-9 continues to fall
  3. CT scans shows no evidence of disease progression

Regimens that are active and demonstrate efficacy are:

  1. 5FU, leucovorin, irinotecan, oxaliplatin (FOLFIORINOX)
  2. 5FU, leucovorin, paclitaxel, oxaliplatin
  3. gemcitabine, 5FU, leucovorin, irinotecan, cisplatin (GFLIP)
  4. Abraxane, gemcitabine
  5. 5FU, leucovorin, Abraxane, oxaliplatin and Avastin
  6. 5FU, leucovorin, Mitomycin-C and Dyparidamole

Radiation combined with single agent chemotherapy does not result in overall survival that is any better than that which was achieved in the 60’s, 70’s or 80’s. There is no conclusive evidence that with patients with a poor performance status will objectively benefit in response or survival from single agent gemcitabine.