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Pancreatic cancer
Hematol Oncol Clin N Am 16 (2002) xi – xii
Preface
Pancreatic cancer
Peter Kozuch, MD
Howard W. Bruckner, MD
This issue of the Hematology/Oncology Clinics of North America is devoted to a discussion of pancreatic cancer. Currently, approximately 30,000 people in the United States are diagnosed with adenocarcinoma of the exocrine pancreas each year. Because diagnosis and intervention occur late in the course of the disease, the vast majority of patients develop metastases. These tumors are relatively resistant to systemic therapy and result in patients’ early death, making pancreatic cancer the fifth leading cause of cancer death in this country. For these reasons, efforts at identifying high risk groups, risk reduction programs, and early detection strategies are as important as improving therapies for more advanced pancreatic cancer. In this edition of the Clinics, articles describe ways to prevent, palliate, and/or treat this disease. In the opening article, Drs. Lowenfels and Maisonneuve discuss epidemiologic work that has identified higher risk populations that may benefit from risk reduction strategies and/or entry into screening or prevention studies. Drs. Hilgers, Rosty, and Hahn contribute an update on the molecular pathogenesis of pancreatic cancer. Knowledge of molecular pathogenesis is being applied to both early detection strategies detailed by Drs. Goggins and Rosty, and to treatment of advanced disease as described by Dr. Wolff. Articles 4, 5, and 6 discuss evaluation and treatment options for potentially resectable and locally advanced, unresectable pancreatic cancer. In the fourth article, Dr. Snady reviews evolving diagnostic, staging, and palliative options available via endoscopic techniques. His article concludes with a review of neoadjuvant strategies for potentially resectable disease. Drs. Cooperman et al review operative and perioperative care of patients with resectable pancreatic cancer. Drs. Ryan and Willet review chemoradiation strategies being incorporated into the care of patients with locally advanced disease. 0889-8588/02/$ - see front matter D 2002, Elsevier Science (USA). All rights reserved. PII: S 0 8 8 9 - 8 5 8 8 ( 0 2 ) 0 0 0 1 0 - 2
xii
Preface / Hematol Oncol Clin N Am 16 (2002) xi–xii
The care of patients with locally advanced and metastatic disease is discussed in articles 7 to 11. Drs. Ellison et al provide a comprehensive overview of symptom management and supportive care in article 7. Drs. Petryk, Bruckner, and I review new chemotherapy agents and novel combinations which may improve the quality of life and survival outcomes of patients with advanced disease. As mentioned above, the article by Dr. Wolff is a comprehensive review of the incorporation of targeted therapies into the treatment of metastatic disease. The current and future development of immunotherapy for pancreatic cancer is detailed by Dr. Kaufman. The techniques of regional chemotherapy and their potential applications are discussed by Drs. Lorenz and Heinrich. It has been a pleasure to guest edit this issue of the Clinics. We thank the authors, leaders in pancreatic cancer research, for their exceptional contributions to this challenging field. Their prompt efforts in writing this book have allowed publication of a particularly current update in this dynamic arena. Dr. Bruckner and I are indebted to the professional publication staff at W.B. Saunders including Kerry Holland and April Woolley for their outstanding assistance. The advances in molecular pathology, imaging modalities, palliative care, and systemic therapy reviewed in this symposium may allow us to better the lives of people with pancreatic cancer. Hopefully, these technologies will one day allow for intervention when the disease is at an earlier, more treatable stage. It is our hope that this edition will be of value to your practice and research efforts. Peter Kozuch, MD Attending Physician Assistant Professor of Clinical Medicine Department of Medical Oncology St. Luke’s-Roosevelt Hospital Center Columbia University College of Physicians and Surgeons New York, NY, USA Howard W. Bruckner, MD Director of Medical Oncology Lutheran Medical Center Brooklyn, NY, USA
Preface
Pancreatic cancer
Peter Kozuch, MD
Howard W. Bruckner, MD
This issue of the Hematology/Oncology Clinics of North America is devoted to a discussion of pancreatic cancer. Currently, approximately 30,000 people in the United States are diagnosed with adenocarcinoma of the exocrine pancreas each year. Because diagnosis and intervention occur late in the course of the disease, the vast majority of patients develop metastases. These tumors are relatively resistant to systemic therapy and result in patients’ early death, making pancreatic cancer the fifth leading cause of cancer death in this country. For these reasons, efforts at identifying high risk groups, risk reduction programs, and early detection strategies are as important as improving therapies for more advanced pancreatic cancer. In this edition of the Clinics, articles describe ways to prevent, palliate, and/or treat this disease. In the opening article, Drs. Lowenfels and Maisonneuve discuss epidemiologic work that has identified higher risk populations that may benefit from risk reduction strategies and/or entry into screening or prevention studies. Drs. Hilgers, Rosty, and Hahn contribute an update on the molecular pathogenesis of pancreatic cancer. Knowledge of molecular pathogenesis is being applied to both early detection strategies detailed by Drs. Goggins and Rosty, and to treatment of advanced disease as described by Dr. Wolff. Articles 4, 5, and 6 discuss evaluation and treatment options for potentially resectable and locally advanced, unresectable pancreatic cancer. In the fourth article, Dr. Snady reviews evolving diagnostic, staging, and palliative options available via endoscopic techniques. His article concludes with a review of neoadjuvant strategies for potentially resectable disease. Drs. Cooperman et al review operative and perioperative care of patients with resectable pancreatic cancer. Drs. Ryan and Willet review chemoradiation strategies being incorporated into the care of patients with locally advanced disease. 0889-8588/02/$ - see front matter D 2002, Elsevier Science (USA). All rights reserved. PII: S 0 8 8 9 - 8 5 8 8 ( 0 2 ) 0 0 0 1 0 - 2
xii
Preface / Hematol Oncol Clin N Am 16 (2002) xi–xii
The care of patients with locally advanced and metastatic disease is discussed in articles 7 to 11. Drs. Ellison et al provide a comprehensive overview of symptom management and supportive care in article 7. Drs. Petryk, Bruckner, and I review new chemotherapy agents and novel combinations which may improve the quality of life and survival outcomes of patients with advanced disease. As mentioned above, the article by Dr. Wolff is a comprehensive review of the incorporation of targeted therapies into the treatment of metastatic disease. The current and future development of immunotherapy for pancreatic cancer is detailed by Dr. Kaufman. The techniques of regional chemotherapy and their potential applications are discussed by Drs. Lorenz and Heinrich. It has been a pleasure to guest edit this issue of the Clinics. We thank the authors, leaders in pancreatic cancer research, for their exceptional contributions to this challenging field. Their prompt efforts in writing this book have allowed publication of a particularly current update in this dynamic arena. Dr. Bruckner and I are indebted to the professional publication staff at W.B. Saunders including Kerry Holland and April Woolley for their outstanding assistance. The advances in molecular pathology, imaging modalities, palliative care, and systemic therapy reviewed in this symposium may allow us to better the lives of people with pancreatic cancer. Hopefully, these technologies will one day allow for intervention when the disease is at an earlier, more treatable stage. It is our hope that this edition will be of value to your practice and research efforts. Peter Kozuch, MD Attending Physician Assistant Professor of Clinical Medicine Department of Medical Oncology St. Luke’s-Roosevelt Hospital Center Columbia University College of Physicians and Surgeons New York, NY, USA Howard W. Bruckner, MD Director of Medical Oncology Lutheran Medical Center Brooklyn, NY, USA