title: Current standards and new innovative approaches for treatment of pancreatic cancer.
abstract: Pancreatic adenocarcinoma remains a devastating disease with a 5-year survival rate not exceeding 6%. Treatment of this disease remains a major challenge. This article reviews the state-of-the-art in the management of this disease and the new innovative approaches that may help to accelerate progress in treating its victims. After careful pre-therapeutic evaluation, only 15-20% of patients diagnosed with a pancreatic cancer (PC) are eligible for upfront radical surgery. After R0 or R1 resection in such patients, evidence suggests a significantly positive impact on survival of adjuvant chemotherapy comprising 6 months of gemcitabine or fluorouracil/folinic acid. Delayed adjuvant chemoradiation is considered as an option in cases of positive margins. Borderline resectable pancreatic cancer (BRPC) is defined as a tumour involving the mesenteric vasculature to a limited extend. Resection of these tumours is technically feasible, yet runs the high risk of a R1 resection. Neoadjuvant treatment probably offers the best chance of achieving successful R0 resection and long-term survival, but the best treatment options should be determined in prospective randomised studies. Gemcitabine has for 15 years been the only validated therapy for advanced PC. Following decades of negative phase III studies, increasing evidence now suggests that further significant improvements to overall survival can be achieved via either Folfirinox or gemcitabine + nab-paclitaxel regimens. Progress in systemic therapy may improve the chances of resection in borderline resectable pancreatic cancer (BRPC) or locally advanced PC. This requires first enhancing knowledge of the genetic events driving carcinogenesis, which may then be translated into clinical studies.
authors: Department of Medical Oncology, Institut de Cancérologie de Lorraine and Lorraine University, 6 avenue de Bourgogne, CS 30519, 54519, Vandoeuvre-lès-Nancy, France. Electronic address: t.conroy@nancy.unicancer.fr.
authors: Thierry
authors: T
authors: Conroy
authors: Department of Hepato-Gastroenterology, Pitié-Salpétrière University Hospital, 47-83 boulevard de l'hôpital, 75651, Paris Cedex 13, France.
authors: Jean-Baptiste
authors: JB
authors: Bachet
authors: Department of Surgery, Nancy University Hospital Lorraine and Lorraine University, rue du Morvan, 54511, Vandoeuvre-lès Nancy, France.
authors: Ahmet
authors: A
authors: Ayav
authors: Department of Radiation Therapy, Tenon Hospital, Paris Est University Hospitals, 4 rue de la Chine, 75020, Paris, France.
authors: Florence
authors: F
authors: Huguet
authors: Department of Medical Oncology, Institut de Cancérologie de Lorraine and Lorraine University, 6 avenue de Bourgogne, CS 30519, 54519, Vandoeuvre-lès-Nancy, France.
authors: Aurélien
authors: A
authors: Lambert
authors: Gustave Roussy Cancer Campus Grand Paris, 114 rue Edouard-Vaillant, 94805, Villejuif Cedex, France.
authors: Caroline
authors: C
authors: Caramella
authors: Department of Gastroenterology, Erasme University Hospital-ULB-Brussels, Lennikstreet 808, 1070, Brussels, Belgium.
authors: Raphaël
authors: R
authors: Maréchal
authors: Department of Gastroenterology, Erasme University Hospital-ULB-Brussels, Lennikstreet 808, 1070, Brussels, Belgium.
authors: Jean-Luc
authors: JL
authors: Van Laethem
authors: Gustave Roussy Cancer Campus Grand Paris, 114 rue Edouard-Vaillant, 94805, Villejuif Cedex, France.
authors: Michel
authors: M
authors: Ducreux
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D058990:Molecular Targeted Therapy / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods; D012015:Reference Standards; D035703:Therapies, Investigational / Q000379:methods*
keywords: Chemotherapy; Imaging; Pancreatic cancer; Radiotherapy; Staging; Surgery; Targeted therapy