title: Addressing the challenges of pancreatic cancer: future directions for improving outcomes.
abstract: Pancreatic ductal adenocarcinoma (PDAC), which accounts for more than 90% of all pancreatic tumours, is a devastating malignancy with an extremely poor prognosis, as shown by a 1-year survival rate of around 18% for all stages of the disease. The low survival rates associated with PDAC primarily reflect the fact that tumours progress rapidly with few specific symptoms and are thus at an advanced stage at diagnosis in most patients. As a result, there is an urgent need to develop accurate markers of pre-invasive pancreatic neoplasms in order to facilitate prediction of cancer risk and to help diagnose the disease at an earlier stage. However, screening for early diagnosis of prostate cancer remains challenging and identifying a highly accurate, low-cost screening test for early PDAC for use in clinical practice remains an important unmet need. More effective therapies are also crucial in PDAC, since progress in identifying novel therapies has been hampered by the genetic complexity of the disease and treatment remains a major challenge. Presently, the greatest step towards improved treatment efficacy has been made in the field of palliative chemotherapy by introducing FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan and oxaliplatin) and gemcitabine/nab-paclitaxel. Strategies designed to raise the profile of PDAC in research and clinical practice are a further requirement in order to ensure the best treatment for patients. This article proposes a number of approaches that may help to accelerate progress in treating patients with PDAC, which, in turn, may be expected to improve the quality of life and survival for those suffering from this devastating disease.
authors.affiliation: Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain. Electronic address: mhidalgo@cnio.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Hidalgo
authors.affiliation: Department of Medical Oncology, University of Ancona, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.affiliation: Department of General Surgery, Technische Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.affiliation: Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Labianca
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: J-Matthias
authors.initials: JM
authors.lastname: Löhr
authors.affiliation: National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit and Cancer Research UK Liverpool Clinical Trials Unit Director, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Neoptolemos
authors.affiliation: Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid and Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
authors.affiliation: Department of Gastroenterology-GI Cancer Unit, Erasme University Hospital, Brussels, Belgium.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Van Laethem
authors.affiliation: Comprehensive Cancer Centre Munich, Klinikum der Universität München, Munich, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D005060:Europe; D006801:Humans; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate
keywords: Management; Outcomes; PDAC; Pancreas; Pathogenesis; Treatment