Systemic treatment for inoperable pancreatic adenocarcinoma: review and update.
There have been many clinical trials conducted to evaluate novel systemic regimens for unresectable pancreatic cancer. However, most of the trial results were negative, and gemcitabine monotherapy has remained the standard systemic treatment for years. A number of molecular targeted agents, including those against epidermal growth factor receptor and vascular endothelial growth factor receptors, have also been tested. In recent years, there have been some breakthroughs in the deadlock: three regimens, namely gemcitabine-erlotinib, FOLFIRINOX, and gemcitabine-nab-paclitaxel, have been shown to prolong the overall survival of patients when compared with gemcitabine monotherapy. In addition, emerging data suggested that the membrane protein human equilibrative nucleotide transporter 1 is a potential biomarker with which to predict the efficacy of gemcitabine. Here we review the literature on the development of systemic agents for pancreatic cancer, discuss the current choices of treatment, and provide future directions on the development of novel agents.
State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology and Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. chanlam_stephen@cuhk.edu.hk.
Stephen L
SL
Chan
Sin T
ST
Chan
Eric H
EH
Chan
Zhe-Xi
ZX
He
D000230:Adenocarcinoma / Q000188:drug therapy*; D000418:Albumins; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives; D003841:Deoxycytidine / Q000031:analogs & derivatives; D033721:Equilibrative Nucleoside Transporter 1; D066246:ErbB Receptors; D000069347:Erlotinib Hydrochloride; D005472:Fluorouracil; D006801:Humans; D002955:Leucovorin; D009944:Organoplatinum Compounds; D017239:Paclitaxel; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D011799:Quinazolines; D040262:Receptors, Vascular Endothelial Growth Factor; D000093542:Gemcitabine
C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D033721:Equilibrative Nucleoside Transporter 1; D009944:Organoplatinum Compounds; D011799:Quinazolines; C438649:SLC29A1 protein, human; D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors; D040262:Receptors, Vascular Endothelial Growth Factor; D017239:Paclitaxel; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin; D000093542:Gemcitabine