&lt;p&gt;Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress&lt;/p&gt;

Barcellini, Amelia; Peloso, Andréa; Pugliese, Luigi; Vitolo, Viviana; Cobianchi, Lorenzo

doi:10.2147/ott.s220971

Cited by 28 publications

(20 citation statements)

References 128 publications

(198 reference statements)

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“…The majority of patients who present with unresectable locally advanced pancreatic cancer (LAPC) or metastatic disease are managed with systemic chemotherapy and/or radiotherapy with a very limited prognosis. The introduction of newer chemotherapy combinations and regimens have shown some promising results but still the overall survival (OS) remains dismal[ 5 , 6 ]. One of the many reasons for failure of systemic chemotherapy has been hypothesized as poor delivery of these agents due to abundant stromal matrix and deficient vasculature[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided injectable therapy for pancreatic cancer: A systematic review

Kaur¹,

Jaruvongvanich²,

Chandrasekhara³

2022

WJG

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BACKGROUND Given the low survival rate in pancreatic cancer, new therapeutic techniques have been explored, especially for unresectable or borderline resectable disease. Endoscopic ultrasound (EUS) provides real-time imaging and minimally invasive access for local and targeted injection of anti-tumor agents directly into the pancreatic tumor. Limited studies have been reported using this technique for the treatment of pancreatic ductal adenocarcinoma (PDAC). AIM To evaluate the progress made with EUS-guided injectable therapies in the treatment of PDAC. METHODS All original articles published in English until July 15, 2021, were retrieved via a library-assisted literature search from Ovid Evidence-Based Medicine Reviews and Scopus databases. Reference lists were reviewed to identify additional relevant articles. Prospective clinical studies evaluating the use of EUS-guided injectable therapies in PDAC were included. Studies primarily directed at non-EUS injectable therapies and other malignancies were excluded. Retrieved manuscripts were reviewed descriptively with on critical appraisal of published studies based on their methods and outcome measures such as safety, feasibility, and effectiveness in terms of tumor response and survival. Heterogeneity in data outcomes and therapeutic techniques limited the ability to perform comparative statistical analysis. RESULTS A total of thirteen articles (503 patients) were found eligible for inclusion. The EUS-injectable therapies used were heterogeneous among the studies consisting of immunotherapy ( n = 5) in 59 patients, chemotherapy ( n = 1) in 36 patients, and viral and other biological therapies ( n = 7) in 408 patients. Eleven of the studies reviewed were single armed while two were double armed with one randomized trial and one non-randomized comparative study. Overall, the included studies demonstrated EUS-guided injectable therapies to be safe and feasible with different agents as monotherapy or in conjunction with other modalities. Promising results were also observed regarding their efficacy and survival parameters in patients with PDAC. CONCLUSION EUS-guided injectable therapies, including immunotherapy, chemotherapy, and viral or other biological therapies have shown minimal adverse events and potential efficacy in the treatment of PDAC. Comparative studies, including controlled trials, are required to confirm these results in order to offer novel EUS-based treatment options for patients with PDAC.

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Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided injectable therapy for pancreatic cancer: A systematic review

Kaur¹,

Jaruvongvanich²,

Chandrasekhara³

2022

WJG

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“…Neoadjuvant chemotherapy should aim in a possible resection, or radiation therapy or IRE. Clinicians and researchers should investigate cancer biology and invest to define predictive and prognostic factors, patients-related features, and biological criteria to identify patients that would benefit from aggressive surgery or chemotherapy and chemoradiation[ 33 ].…”

Section: Oncologymentioning

confidence: 99%

Current status of non-surgical treatment of locally advanced pancreatic cancer

Spiliοpoulos¹,

Zurlo²,

Casella³

et al. 2021

WJGO

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Pancreatic cancer is the 7 th leading cause of death due to cancer in industrialized countries and the 11 th most common cancer globally, with 458918 new cases (2.5% of all cancers) and 432242 deaths (4.5% of all cancer deaths) in 2018. Unfortunately, 80% to 90% of the patients present with unresectable disease, and the reported 5-year survival rate range between 10% and 25%, even after successful resection with tumor-free margins. Systemic chemotherapy, radiotherapy, and minimally invasive image-guided procedures that have emerged over the past years, are used for the management of non-operable PC. This review focuses on currently available non-surgical options of locally advanced pancreatic cancer.

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“…Risk factors for PC have been extensively studied over the last few years [1,[14][15][16][17]. Age is considered the most critical determinant, as most patients are diagnosed at age > 50, with a particularly higher incidence between 70 and 80.…”

Section: Risk Factorsmentioning

confidence: 99%

Targeting Pancreatic Ductal Adenocarcinoma (PDAC)

Parrasia

Zoratti

Szabó

et al. 2020

Cell Physiol Biochem

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Pancreatic cancers are among the most ominous, and among the most studied. Their complexities have provided ample material for a huge investigative effort, which is briefly surveyed in this review. Eradication by surgery has proven extremely difficult, and a successful chemotherapeutic approach is desperately needed. Treatment with "traditional" anticancer drugs, such as benchmark gemcitabine or the current standard-of-care FOLFIRINOX quaternary combination increase the mean overall survival by only a few months and often leads to chemoresistance. Much work is therefore currently devoted to potentiating our pharmacological weapons by accurate targeting and, in particular, by acting on the dense tumoral stroma, a distinctive feature of PDAC accounting for much of the therapeutic difficulty. We give an overview of recent developments, touching on the major aspects of PDAC physiology and biochemistry, currently-used and experimental drugs, and targeting technologies under development. A few papers are discussed in some detail to help provide a sense of how the field is moving.

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<p>Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress</p>

Cited by 28 publications

References 128 publications

Endoscopic ultrasound-guided injectable therapy for pancreatic cancer: A systematic review

Endoscopic ultrasound-guided injectable therapy for pancreatic cancer: A systematic review

Current status of non-surgical treatment of locally advanced pancreatic cancer

Targeting Pancreatic Ductal Adenocarcinoma (PDAC)

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