Current Approaches in the Treatment of Pancreatic Cancer
Kürşat DİKMENa , Muhammed Tarık YILMAZa
aGazi University Medical Faculty, Department of General Surgery, Ankara, Türkiye
Dikmen K, Yılmaz MT. Current approaches in the treatment of pancreatic cancer. In: Yar Sağlam AS, ed. Innovative Approaches in Cancer Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.32-7.
Makale Dili: EN
ABSTRACT
Pancreatic cancer, like in the rest of the world, ranks 4th among cancer-related deaths in our country. The majority of patients are diagnosed with unresectable or metastatic disease. A multidisciplinary approach is necessary to increase survival and determine the most optimal treatment plan. The quality and safety of pancreatic cancer surgery has greatly improved in recent years with the development of minimal invasive techniques, the advancement of chemotherapeutic and immunotherapeutic drugs, and the increasing use of neoadjuvant chemotherapy and radiotherapy. The use of genomic tests in metastatic pancreatic cancer has increased, leading to a better understanding of their biology and allowing clinicians to evaluate potential target-directed therapies. Similarly, promising results have emerged with the use of PARP inhibitors and other target-directed agents. However, pancreatic cancer continues to be a disease with poor long-term survival. Nevertheless, recent developments have improved outcomes and necessitated a change in treatment protocols related to this disease in the past decade. The purpose of this review is to summarize current practices in pancreatic cancer treatment and the milestones that have brought us to where we are today, along with new treatments.
Keywords: Pancreatic neoplasms; therapy
Referanslar
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA A Cancer J Clin. 2019;69(1):1-11. [Crossref] [PubMed]
- National Cancer Institute. Surveillance, Epidemiology and End Results Program. 2020. [Link]
- Fernández-del Castillo C, Morales-Oyarvide V, McGrath D, et al. Evolution of the whipple procedure at the Massachusetts general hospital. Surgery. 2012;152(3 Suppl 1):S56-S63. [Crossref] [PubMed] [PMC]
- Gallitano A, Fransen H, Martin RG. Carcinoma of the pancreas. Results of treatment. Cancer. 1968;22(5):939-44. [Crossref] [PubMed]
- Eisenberg JD, Rosato EL, Lavu H, Yeo CJ, Winter JM. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg. 2015;19(9):1572-80. [Crossref] [PubMed]
- Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006;10(9):1199-211. [Crossref] [PubMed]
- Hata T, Motoi F, Ishida M, et al. Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg. 2016;263(4):664-72. [Crossref] [PubMed]
- Strobel O, Lorenz P, Hinz U, et al. Actual five-year survival after upfront resection for pancreatic ductal adenocarcinoma: who beats the odds? Ann Surg. 2020;275(5):962-71. [Crossref] [PubMed]
- Kolbeinsson H, Hoppe A, Bayat A, et al. Recurrence patterns and postrecurrence survival after curative intent resection for pancreatic ductal adenocarcinoma. Surgery. 2021;169(3):649-54. [Crossref] [PubMed]
- Van Tienhoven G, Versteijne E, Suker M, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC-1): A randomized, controlled, multicenter phase III trial. JCO. 2018;36(18_suppl):LBA4002-LBA4002. [Crossref]
- Bold RJ, Charnsangavej C, Cleary KR, et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg. 1999;3(3):233-43. [Crossref] [PubMed]
- Chua TC, Saxena A. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010;14(9):1442-52. [Crossref] [PubMed]
- Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408-10. [Crossref] [PubMed]
- Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015;19(1):189-94; discussion 194. [Crossref] [PubMed]
- Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13(7):454-8. [Crossref] [PubMed] [PMC]
- Jiang Y-L, Zhang R-C, Zhou Y-C. Comparison of overall survival and perioperative outcomes of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. BMC Cancer. 2019;19(1):781. [Crossref] [PubMed] [PMC]
- Song KB, Kim SC, Hwang DW, et al. Matched case-control analysis comparing laparoscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors. Ann Surg. 2015;262(1):146-55. [Crossref] [PubMed]
- Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014;260(4):633-40. [Crossref] [PubMed]
- Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg. 2015;262(2):372-7. [Crossref] [PubMed]
- Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. N Engl J Med. 2019;381(4):317-27. [Crossref] [PubMed] [PMC]
- Carrato A, Vieitez JM, Benavides M, et al. Phase I/II trial of sequential treatment of nab-paclitaxel in combination with gemcitabine followed by modified FOLFOX chemotherapy in patients with untreated metastatic exocrine pancreatic cancer: Phase I results. Eur J Cancer. 2020;139:51-8. [Crossref] [PubMed]
- Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389(10073):1011-24. [Crossref] [PubMed]
- Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395-406. [Crossref] [PubMed]
- Kalser MH, Ellenberg SS. Pancreatic cancer: adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120(8):899-903. [Crossref] [PubMed]
- Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg. 1999;230(6):776-82; discussion 782-4. [Crossref] [PubMed] [PMC]
- Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200-10. [Crossref] [PubMed]
- Palta M, Godfrey D, Goodman KA, et al. Radiation therapy for pancreatic cancer: executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol. 2019;9(5):322-32. [Crossref] [PubMed]
- Miyasaka Y, Ohtsuka T, Kimura R, et al. Neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel for borderline resectable pancreatic cancer potentially improves survival and facilitates surgery. Ann Surg Oncol. 2019;26(5):1528-34. [Crossref] [PubMed]
- Okada K-I, Hirono S, Kawai M, et al. Phase I study of nab-paclitaxel plus gemcitabine as neoadjuvant therapy for borderline resectable pancreatic cancer. Anticancer Res. 2017;37(2):853-8. [Crossref] [PubMed]
- Barbour AP, Samra JS, Haghighi KS, et al. The AGITG GAP study: a phase ii study of perioperative gemcitabine and nab-paclitaxel for resectable pancreas cancer. Ann Surg Oncol. 2020;27(7):2506-15. [Crossref] [PubMed]
- OʼReilly EM, Perelshteyn A, Jarnagin WR, et al. A single-arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma. Ann Surg. 2014;260(1):142-8. [Crossref] [PubMed] [PMC]
- Versteijne E, Vogel JA, Besselink MG, et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg. 2018;105(8):946-58. [Crossref] [PubMed] [PMC]
- Hackert T, Niesen W, Hinz U, et al. Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol. 2017;43(2):358-63. [Crossref] [PubMed]
- Adam R, Chiche L, Aloia T, et al. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg. 2006;244(4):524-35.
- Shrikhande SV, Kleeff J, Reiser C, et al. Pancreatic Resection for M1 Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol. 2007;14(1):118-27. [Crossref] [PubMed]
- Ilmer M, Schiergens TS, Renz BW, et al. Oligometastatic pulmonary metastasis in pancreatic cancer patients: Safety and outcome of resection. Surg Oncol. 2019;31:16-21. [Crossref] [PubMed]
- Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817-25. [Crossref] [PubMed]
- Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691-703. [Crossref] [PubMed] [PMC]
- Wang-Gillam A, Li C-P, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet (London, England). 2016;387(10018):545-57. [Crossref]
- Dalmasso B, Puccini A, Catalano F, et al. Beyond BRCA: the emerging significance of DNA damage response and personalized treatment in pancreatic and prostate cancer patients. IJMS. 2022;23(9):4709. [Crossref] [PubMed] [PMC]
- Registry. APG. Pancreatic Cancer Genomic Distribution: Mutated Genes. Published 2022. [Link]
- Strickler JH, Satake H, Hollebecque A, et al. First data for sotorasib in patients with pancreatic cancer with KRAS p.G12C mutation: A phase I/II study evaluating efficacy and safety. JCO. 2022;40(36_suppl):360490-360490. [Crossref]
- Leidner R, Sanjuan Silva N, Huang H, et al. Neoantigen T-cell receptor gene therapy in pancreatic cancer. N Engl J Med. 2022;386(22):2112-9. [Crossref] [PubMed] [PMC]