Ablation in Pancreatic Cancer: Past, Present and Future

Narayanan, Govindarajan; Daye, Dania; Wilson, Nicole M.; Noman, Raihan; Mahendra, Ashwin M.; Doshi, Mehul

doi:10.3390/cancers13112511

Cited by 23 publications

(10 citation statements)

References 49 publications

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“…The risk of pancreatic cancer is strongly associated with age, smoking, excessive BMI, genetic and family history, diabetes, or chronic pancreatitis ( 1 ). At the time of diagnosis, patients are often diagnosed with locally advanced (Stage III, 35%) or metastatic (Stage IV, 50%) pancreatic cancer, which is generally identified as UAPC according to international consensus ( 8 ). In recent years, retrospective studies have shown that patients with UAPC may benefit from surgery, and patients with systemic treatment followed by surgery have a better prognosis than those treated only with surgery.…”

Section: Discussionmentioning

confidence: 99%

Case report: Two PD-L1 positive unresectable advanced pancreatic carcinoma patients with microsatellite stability achieved R0 resection after PD-1 antibody plus chemotherapy as a successful downstaging therapy: A report of two cases

Lin¹,

Fan²,

Zhao³

et al. 2022

Front. Immunol.

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BackgroundNonobvious early symptoms are a prominent characteristic of pancreatic cancer, resulting in only 20% of patients having resectable tumors at the time of diagnosis. The optimal management of unresectable advanced pancreatic cancer (UAPC) remains an open research question. In this study, the tumors shrank significantly after PD-1 antibody combined with chemotherapy in two UAPC patients, and both have achieved R0 (pathologically negative margin) resection and survival to date.Case presentationCase 1: A 53-year-old man was diagnosed with pancreatic adenocarcinoma (Stage III). He received six cycles of PD-1 antibody plus chemotherapy as the first-line treatment. The tumor was reduced from 11.8×8.8 cm to “0” (the pancreatic head was normal as shown by enhanced computed tomography, ECT) after preoperative neoadjuvant therapy (PNT) and the adverse effects were tolerable. The patient underwent radical surgery and achieved R0 resection. Case 2: A 43-year-old man diagnosed with pancreatic adenocarcinoma with liver metastasis (Stage IV) received three cycles of PD-1 antibody combined with chemotherapy. The tumor was reduced from 5.2×3.9 cm to 2.4×2.3 cm with no side effects. The patient also underwent radical surgery and achieved R0 resection.ConclusionPD-1 antibody plus a chemotherapy regimen resulted in a surprising curative effect and safety in two patients with UAPC, which may portend an improvement in pancreatic carcinoma treatment. We may have a way for UAPC patients to obtain radical treatment and gain long-term survival. Two PD-L1 positive UAPC patients with microsatellite stability (MSS) enlighten us to have a more comprehensive understanding of the prediction of immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Case report: Two PD-L1 positive unresectable advanced pancreatic carcinoma patients with microsatellite stability achieved R0 resection after PD-1 antibody plus chemotherapy as a successful downstaging therapy: A report of two cases

Lin¹,

Fan²,

Zhao³

et al. 2022

Front. Immunol.

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“…Irreversible electroporation (IRE) is an ambient temperature physical ablation technique that is performed by applying high voltage electrical pulses to tumor cells through electrodes to produce nano-scale irreversible electroporation on the cell membrane, resulting in the death of tumor cells. Its most significant advantage is that it causes minimal damage to major anatomical structures in the ablation area, such as arteries, veins, nerves, bile ducts, trachea, intestines, and ureters, and can effectively protect the structural integrity of the vasculature ( 3 ). IRE is particularly suitable for the ablation of tumors located in essential structures such as the pancreas, hilar region, and retroperitoneum, which cannot be treated by other physical ablations ( 35 ).…”

Section: Local Physical and Chemical Ablation Of Solid Tumorsmentioning

confidence: 99%

“…Imaging-guided techniques have promoted the development of physical and chemical ablation-based therapies. Thermal ablation includes microwave ablation, radiofrequency ablation, laser ablation, cryoablation, and irreversible electroporation with voltage pulses ( 1 – 3 ). Chemical ablation refers to the procedure of inactivating tumor cells by injecting chemical ablative agents directly into the solid tumor using a fine needle under imaging guidance.…”

Section: Introductionmentioning

confidence: 99%

Chemo-immunoablation of solid tumors: A new concept in tumor ablation

2023

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Chemical ablation was designed to inject chemical agents directly into solid tumors to kill cells and is currently only used clinically for the palliative treatment of tumors. The application and combination of different drugs, from anhydrous ethanol, and glacial acetic acid to epi-amycin, have been clinically tested for a long time. The effectiveness is unsatisfactory due to chemical agents’ poor diffusion and concentration. Immunotherapy is considered a prospective oncologic therapeutic. Still, the clinical applications were limited by the low response rate of patients to immune drugs and the immune-related adverse effects caused by high doses. The advent of intratumoral immunotherapy has well addressed these issues. However, the efficacy of intratumoral immunotherapy alone is uncertain, as suggested by the results of preclinical and clinical studies. In this study, we will focus on the research of immunosuppressive tumor microenvironment with chemoablation and intratumoral immunotherapy, the synergistic effect between chemotherapeutic drugs and immunotherapy. We propose a new concept of intratumoral chemo-immunoablation. The concept opens a new perspective for tumor treatment from direct killing of tumor cells while, enhancing systemic anti-tumor immune response, and significantly reducing adverse effects of drugs.

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“…Common complications associated with RFA also tend to include pancreatic fistulas, portal thromboses, and pancreatitis [ 121 ]. While the data concerning MWA complications is more sparce, possible complications include mild pancreatitis, hyperamylasemia, pancreatic ascites, mild hemorrhage, and pseudocysts [ 121 , 122 ]. Possible complications for cryoablation include pancreatic and bile leak, gastrointestinal bleeding and obstruction, infection, and hemorrhage [ 122 ].…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

et al. 2022

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Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.

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Ablation in Pancreatic Cancer: Past, Present and Future

Cited by 23 publications

References 49 publications

Case report: Two PD-L1 positive unresectable advanced pancreatic carcinoma patients with microsatellite stability achieved R0 resection after PD-1 antibody plus chemotherapy as a successful downstaging therapy: A report of two cases

Case report: Two PD-L1 positive unresectable advanced pancreatic carcinoma patients with microsatellite stability achieved R0 resection after PD-1 antibody plus chemotherapy as a successful downstaging therapy: A report of two cases

Chemo-immunoablation of solid tumors: A new concept in tumor ablation

Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

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