The Potential Role of Curcumin for Treatment of Pancreatic Cancer

Gemcitabine has been the standard chemotherapy for advanced pancreatic cancer since 1997, when a randomized phase III study demonstrated that gemcitabine significantly improved cancer-related symptoms in comparison with 5-fluorouracil (5-FU) (Burris et al., 1997). However, the survival benefit of gemcitabine is modest and the median survival time was 5.7 and 4.4 months for gemcitabine and 5-FU arm, respectively. Thus the prognosis of this disease still remains dismal and the development of a more effective therapy is urgently needed in daily clinical practice. For the past decade, many efforts have been made to improve the overall survival of patients with this disease by adding a second cytotoxic agent to gemcitabine. Several large phase III trials have compared gemcitabine alone with gemcitabine combination therapy (e.g. capecitabine, 5fluorouracil, irinotecan, oxaliplatin, pemetrexed). However, none of them could demonstrate a significant survival advantage for the gemcitabine combination therapy over the gemcitabine monotherapy, despite a significant improvement in response rates (Berlin et al., 2002; Herrmann et al., 2007; Louvet et al., 2005; Oettle et al., 2005; Rocha Lima et al., 2004). It is likely that the benefit of adding a second cytotoxic agent to gemcitabine is countered by increased toxicity and the decreased dose intensity of gemcitabine. Therefore, a new approach other than adding cytotoxic agents to gemcitabine is warranted. Since pancreatic cancer patients often suffer from cancer-related symptoms (e.g. fatigue, appetite loss, pain), it is very important to maintain a balance between efficacy and quality of life in palliative chemotherapy.