Locally advanced pancreatic cancer — new therapeutic challenges

Abstract

The overall survival rate of patients with pancreatic ductal adenocarcinoma remains extremely poor, and the only potentially curative treatment is radical surgery. There are three subgroups among the patients: primary resectable, metastatic and locally advanced pancreatic cancer. The term of locally ad advanced pancreatic cancer includes borderline resectable pancreatic cancer (BRPC) and unresectable pancreatic cancer (URPC). As in the case of BRPC, the strategy of induction treatment may convert the inoperable tumour into a resectable one. As in the case of URPC, the optimal standard of treatment is unknown. Recent advances in systemic treatment such as FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, oxaliplatin) and gemcitabine plus nab-paclitaxel as well as the optimisation of local treatment such as stereotactic radiotherapy (SBRT-stereotactic body radiation therapy) should be incorporated into future trials dedicated for BRPC and URPC.

A change in the approach to pancreatic head cancer resection?

“…Recent advances in systemic treatment, such as the use of FOLFIRINOX regimens (5fluorouracil, leucovorin, irinotecan, oxaliplatin) and gemcitabine plus nab-paclitaxel, as well as optimisation of local treatment, e.g., stereotactic body radiation therapy (SBRT), have led to an increase in the proportion of patients where a resection is possible. This is especially true for the subgroup of patients with borderline resectable tumours [1]. Moreover, modifications have been made to surgical treatment.…”

Pancreatic cancer concomitant with other malignancies – single centre experience

“…Effective screening is unavailable; thus, most patients present with a locally advanced (30-35%) or metastatic (50-55%) stage of the disease at diagnosis. Tumour cells are highly invasive, leading to further disease development and progression [4][5][6].…”

The Poly(ADP-ribose) polymerase inhibitors in pancreatic cancer

“…The majority of patients at the time of diagnosis present unresectable tumours due to either local extension or distant metastases. The current treatment options for patients with metastatic PC include fibrinolysin, gemcitabine with nab-paclitaxel, or erlotinib regimens which significantly improved the clinical outcomes in comparison to gemcitabine monotherapy that was the standard therapy for many years [3,4].…”