Rationale for an Intraperitoneal Gemcitabine Chemotherapy Treatment for Patients with Resected Pancreatic Cancer

Currently, the surgical management of pancreas cancer is recognized around the world as inadequate. Long-term survival is rare even though there is a potentially curative R0 resection. There is a strong rationale for the use of chemotherapy in the operating room to reduce local-regional and hepatic sites of recurrent/progressive disease. Gemcitabine monotherapy administered by an intraperitoneal route in the operating room with hyperthermia and then for long-term treatment postoperatively has a strong pharmacologic basis. The exposure of peritoneal surfaces to intraperitoneal gemcitabine is approximately 500 times the exposure that occurs within the plasma. By analogy to another lethal disease, ovarian cancer, intraperitoneal gemcitabine chemotherapy using following potentially curative resection is supported. A standardized treatment with intraoperative chemotherapy monitoring of gemcitabine would greatly facilitate further improvements in pancreas cancer treatment and lead the way to an evolution of more successful treatment strategies of this dread disease. The aim of this chapter is to present the recent available medical information and patents applicable to patients with resected pancreatic cancer.

Keywords: Cancer pharmacology, chemoradiation therapy, chemotherapy, gemcitabine, gemcitabine monotherapy, hepatic metastases, hyperthermia, intraperitoneal chemotherapy, intraperitoneal port, local recurrence, local-regional recurrent disease, long-term intraperitoneal chemotherapy, pancreas cancer, pharmacokinetics, randomized trials.