Current Systemic Treatment Options for Metastatic and Unresectable Pancreatic Cancer

Abstract

Metastatic and local advanced unresectable pancreatic cancers are lethal conditions that always carry a poor prognosis with rare exceptions. Currently, the mainstay of therapy is cytotoxic chemotherapy plus best supportive care. First-line therapy for patients with a good performance status includes FOLFIRINOX or gemcitabine plus nab-paclitaxel regimens. Patients carrying a deleterious germline BRCA mutation can be treated with maintenance olaparib after FOLFIRINOX. Patients with a poor performance status, but still fit enough for chemotherapy, may be treated with single agent gemcitabine. Second-line therapy will depend on previous therapy and current performance status. Options for patients treated with gemcitabine-based regimens are 5-fluorouracil plus leucovorin plus either nanoliposomal irinotecan, irinotecan or oxaliplatin. Patients that were treated with first line FOLFIRINOX may benefit from a gemcitabine-based chemotherapy, but evidence from randomized trials is lacking. Other options like immunotherapy and targeted therapies yield benefit only in very selected cases, and it is still an area of research.

The Reallife Comparison of FOLFIRINOX vs Gemcitabine Platinum Combination as a First-Line Treatment in Patients with Pancreatic Carcinoma

“…13 In our study, mucositis, neutropenia, and neuropathy were observed in the gemcitabine plus platinum group at a similar rate to that in the literature. 16 These side effects were also detected more frequently in patients receiving FOLFIRINOX compared to those receiving gemcitabine platinum, which is consistent with the literature. 16 However, thrombocytopenia has been detected more frequently than in the literature, and diarrhea is less common than in the literature.…”

“…16 These side effects were also detected more frequently in patients receiving FOLFIRINOX compared to those receiving gemcitabine platinum, which is consistent with the literature. 16 However, thrombocytopenia has been detected more frequently than in the literature, and diarrhea is less common than in the literature. [4][5][6] In our study, the combination of gemcitabine and platinum-enhanced chemotherapy seemed more tolerable than FOLFIRINOX group.…”