Advances in the treatment of pancreatic cancer: Limitations of surgery and evaluation of new therapeutic strategies

Abstract

Pancreatic ductal carcinoma is one of the most dismal malignancies of the gastrointestinal system. Even after curative resection, the actual 5-year survival is only 10%-20%. Of all the treatments used against pancreatic cancer, surgery is still the only one that can achieve complete cure. Pancreatic cancer spreads easily to the adjacent tissues and distant metastasis is common. Typically, this cancer invades the retropancreatic neural tissue, duodenum, portal vein (PV), and superior mesenteric vein (SMV), or regional lymph nodes. For this reason, aggressive surgery that removes the cancerous lesion completely is recommended. Several retrospective and prospective studies have been conducted to validate the usefulness of aggressive surgery for pancreatic cancer in the past few decades. Surprisingly, the survival benefits of aggressive surgery have been denied by most randomized controlled trials (RCTs). This implies that surgery alone is not enough. Thus, adjuvant therapy, such as radiotherapy and chemotherapy, has been given in combination with surgery to improve survival. Although the benefits of radiotherapy alone are limited, the results of chemotherapy are promising. Other newly evolving molecular targeting drugs may also improve the treatment outcomes of pancreatic cancer.

Targeted Degradation of KRAS by an Engineered Ubiquitin Ligase Suppresses Pancreatic Cancer Cell Growth In Vitro and In Vivo

“…These oncogenic or tumor suppressor genes play key roles in the progression and metastasis of pancreatic cancer (29). An increasing number of researchers and clinicians are focusing their attention on gene therapy methods for preventing and treating pancreatic cancer (30).…”

Involvement of water pipe smoking in the development of human pancreatic cancer

“…Recognized risk factors for the cancer include cigarette smoking, chronic and hereditary pancreatitis, history of diabetes and familial cancer syndromes. 2,3 This cancer is one of the most difficult conditions to treat, although it only accounts for 3% of all cancers; 5-year survival rate is about 5% in pancreatic cancer patients, and this figure remains largely unchanged over the past 3 decades. 3 Therefore, identification of new behavior risk factors as a prevention measure is crucial.…”

“…2,3 This cancer is one of the most difficult conditions to treat, although it only accounts for 3% of all cancers; 5-year survival rate is about 5% in pancreatic cancer patients, and this figure remains largely unchanged over the past 3 decades. 3 Therefore, identification of new behavior risk factors as a prevention measure is crucial. On the other hand, water pipe smoking (WPS) is traditional and common especially in the Eastern Mediterranean Region, 4,5 as it is believed that 20% of adult people living in these countries smoke water pipe.…”

Ethyl Pyruvate Inhibits Pancreatic Tumor Growth in Mice

“…But, due to this aggressive disease, most pancreatic cancer patients have early metastasis by the time of diagnosis, and only a few cases can undergo surgical resection. Even among cases undergoing resection, the longterm outcome remains unsatisfactory because of early recurrence and metastasis [4]. Although significance advances have been made in the understanding the biology of pancreatic cancer, the molecular and cellular mechanisms involved in the metastasis and recurrence in the early stage or after resection remain poorly understood.…”