Toward treatment optimization for patients with pancreatic and esophagogastric cancer

This thesis examines treatments and predictive biomarkers for pancreatic cancer and esophagogastric cancer. Chapter 1 provides an introduction to the disease profiles, incidence, and treatment options. Patients with locally unresectable pancreatic carcinoma (LAPC) or metastatic pancreatic carcinoma are usually not eligible for curative treatment and receive palliative chemotherapy to improve survival and alleviate symptoms. In LAPC, reconsideration of resection may be possible depending on the response to induction therapy. Chapter 2 investigates the addition of the EGFR antibody panitumumab to gemcitabine-based chemoradiation for LAPC. The study confirmed the feasibility of this combination, with side effects such as nausea and rash, but its effectiveness cannot be determined in a phase 1 trial. Chapter 3 describes a cohort study on the reintroduction of FOLFIRINOX after a treatment-free period. The results suggest that reintroduction may be beneficial for patients with a good response and limited side effects during the initial treatment. Chapter 4 discusses a phase 2 study that added folic acid and vitamin B12 to cisplatin and gemcitabine for advanced esophagogastric cancer. The study showed no significant improvement in response or survival, which is relevant for patients considering vitamin supplementation. Chapter 5 explores the role of microRNAs (miRNAs) as biomarkers. A correlation was found between high expression of miR-375 and better survival in esophageal adenocarcinoma, while other miRNAs showed no significant predictive value. The research highlights the need for further studies on treatments and biomarker selection to improve outcomes for patients with pancreatic and esophagogastric cancer.