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2014 ; 1
(4
): 167-79
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Pancreatic Cancer: Progress in Systemic Therapy
#MMPMID26672477
Perkhofer L
; Ettrich TJ
; Seufferlein T
Gastrointest Tumors
2014[May]; 1
(4
): 167-79
PMID26672477
show ga
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of
cancer-related deaths in the Western world. Due to lack of specific symptoms and
no accessible precursor lesions, primary diagnosis is commonly delayed, resulting
in the identification of only 15-20% of patients with potentially curable
disease. The major limiting factor is an already locally advanced or metastatic
disease at the time of diagnosis. Consequently, systemic therapy forms the
backbone of treatment strategy for the majority of patients. SUMMARY: A deeper
understanding of the molecular characteristics of pancreatic cancer has led to
the identification of several potential therapeutic targets. A variety of
targeted therapies are currently under clinical evaluation as single agents or in
combination with chemotherapy for PDAC. This review highlights the current state
of chemotherapy in pancreatic cancer and provides an outlook on its future
perspectives. KEY MESSAGE: This review focuses on the current chemotherapy
regimens for the systemic treatment of PDAC. PRACTICAL IMPLICATIONS: Various
neoadjuvant approaches have been explored, including chemoradiation, chemotherapy
followed by chemoradiation or intensified chemotherapy without defining a
standard of care so far. The standard of care is gemcitabine or 5-fluorouracil.
The oral fluoropyrimidine S-1 may be a promising new agent in this setting. For
first-line treatment of metastatic pancreatic cancer, no targeted therapy has yet
demonstrated clinical benefit apart from the combination of the tyrosine kinase
inhibitor erlotinib plus gemcitabine. Recently, novel chemotherapeutic regimens
such as FOLFIRINOX and gemcitabine plus nanoparticle albumin-bound paclitaxel
have been introduced. Both combinations have proved to be superior to the
standard gemcitabine regimen. For second-line treatment the combination of
5-fluorouracil/leucovorin and oxaliplatin yields improved results compared to
best supportive care.
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