#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
preLekára.sk / Journals / Perspectives in Surgery / 2024 - 4

Pancreatic cancer – systemic treatment

Česká verzia

Authors: M. Liberko 1,2
Authors place of work: Onkologická klinika Fakultní nemocnice Královské Vinohrady, Praha, Česká republika 1;  3. lékařská fakulta Univerzity Karlovy, Praha, Česká republika 2
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 4, s. 110-116.
Category: Review
doi: https://doi.org/10.33699/PIS.2024.103.4.110–116

Summary

Pancreatic cancer is a disease with the worst long-term survival across all stages. In clinical practice, due to asymptomatic or non-specific signs and symptoms we diagnose patients mainly with locally advanced and metastatic disease, where median survival is approximately one year. However, cases of an early local recurrence or distant metastases are observed even in early stages after curative surgery, and long-term survival is an exception even in these early stages of the disease. Despite these adverse characteristics, an improvement in median overall survival has been observed also in patients with pancreatic cancer, particularly in the last few years. It is due to advancements in the diagnosis, surgery, but mainly due to improvements in cancer treatment (chemotherapy – adjuvant, neoadjuvant, perioperative, induction and palliative, and radiotherapy). The results of many studies across all stages (resectable, borderline resectable, locally advanced, metastatic) have been published, showing an improved survival. The aim of this article is to provide a review of current treatment options for pancreatic ductal adenocarcinoma.

Keywords:

Chemotherapy – radiotherapy – resectable pancreatic cancer – borderline resectable pancreatic cancer – locally advanced pancreatic cancer – metastatic pancreatic cancer

Zdroje
  1. Brunner M, Wu Z, Krautz C, et al. Current clinical strategies of pancreatic cancer treatment and open molecular questions. Int J Mol Sci. 2019;20:4543. doi:10.3390/ijms20184543.
  2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
  3. Ducreux M, Cuhna AS, Caramella C, et al. ESMO Guidelines Committee. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26 Suppl 5:v56–68. doi:10.1093/annonc/mdv295. Erratum in: Ann Oncol. 2017 Jul 1;28(suppl_4):iv167-iv168. PMID: 26314780.
  4. Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55:1158–1160. doi:10.1080/0284186X.2016.1197419.
  5. Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: Global trends, etiology and risk factors. World J Oncol 2019;10:10–27.
  6. https://www.svod.cz/
  7. Guo J, Xie K, Zheng S. Molecular biomarkers of pancreatic intraepithelial neoplasia and their implications in early diagnosis and therapeutic intervention of pancreatic cancer. Int J Biol Sci. 2016 Jan 28;12(3):292–301. doi:10.7150/ijbs.14995.
  8. Neoptolemos JP, Dunn JA, Stocken DD, et al. European Study Group for Pancreatic Cancer. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet 2001 Nov 10;358(9293):1576–1585. doi: 10.1016/s0140-6736(01)06651-x.
  9. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007 Jan 17;297(3):267–277. doi:10.1001/ jama.297.3.267.
  10. Neoptolemos JP, Stocken DD, Bassi C, et al. European Study Group for Pancreatic Cancer. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 2010 Sep 8;304(10):1073–1081. doi:10.1001/jama.2010.1275.
  11. Neoptolemos JP, Palmer DH, Ghaneh P, et al. European Study Group for Pancreatic Cancer. 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 Mar 11;389(10073):1011–1024. doi:10.1016/S0140-6736(16)32409-6.Epub 2017 Jan 25.
  12. Conroy T, Hammel P, Hebbar M, et al. Canadian Cancer Trials Group and the Unicancer-GI–PRODIGE Group. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018 Dec 20;379(25):2395–2406. doi:10.1056/ NEJMoa1809775.
  13. Tempero MA, Reni M, Riess H, et al. APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma. J Clin Oncol. 2019;37(suppl 15):4000.
  14. Tempero MA, Reni M, Riess H, et al. Phase III, international, multicenter, randomized, open-label trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) alone for surgically resected pancreatic adenocarcinoma (APACT): Subgroup analyses. Annals of Oncology 2019;30:259–260. doi:10.1093/ annonc/mdz247.010.
  15. Lim KH, Chung E, Khan A, et al. Neoadjuvant therapy of pancreatic cancer: the emerging paradigm? Oncologist 2012;17(2):192–200. doi:10.1634/theoncologist.2011-0268.
  16. Palta M, Willett C, Czito B. Role of radiation therapy in patients with resectable pancreatic cancer. Oncology (Williston Park) 2011 Jul;25(8):715–721,727.
  17. Takahashi H, Ogawa H, Ohigashi H, et al. Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma. Surgery 2011 Sep;150(3):547–556. doi:10.1016/j.surg.2011.03.001. Epub 2011 May 31.
  18. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006 Aug;13(8):1035–1046. doi: 10.1245/ASO.2006.08.011. Epub 2006 Jul
  19. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009 Jul;16(7):1727–1733. doi:10.1245/ s10434-009-0408-6. Epub 2009 Apr 24.
  20. Abrams RA, Lowy AM, O‘Reilly EM, et al. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009 Jul;16(7):1751–1756. doi:10.1245/s10434-009-0413-9. Epub 2009 Apr 24.
  21. NCCN guidelines. Pancreatic adenocarcinoma. Version 2.2021
  22. Versteijne E, Suker M, Groothuis K, et al. Dutch Pancreatic Cancer Group. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Results of the Dutch randomized phase III PREOPANC Trial. J Clin Oncol. 2020 Jun 1;38(16):1763–1773. doi: 10.1200/ JCO.19.02274. Epub 2020 Feb 27.
  23. Katz MH, Shi Q, Ahmad SA, et al. Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for clinical trials in oncology trial A021101. JAMA Surg. 2016 Aug 17;151(8):e161137. doi:10.1001/jamasurg.2016.1137. Epub 2016 Aug 17.
  24. Murphy JE, Wo JY, Ryan DP, et al. Total neoadjuvant therapy with FOLFIRINOX followed by individualized chemoradiotherapy for borderline resectable pancreatic adenocarcinoma: A phase 2 clinical trial. JAMA Oncol. 2018 Jul 1;4(7):963–969. doi:10.1001/jamaoncol.2018.0329. Erratum in: JAMA Oncol. 2018 Oct 1;4(10):1439.
  25. Murphy JE, Wo JY, Ryan DP, et al. Total neoadjuvant therapy with FOLFIRINOX in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: A phase 2 clinical trial. JAMA Oncol. 2019 Jul 1;5(7):1020–1027. doi:10.1001/jamaoncol.2019.0892.
  26. Tran NH, Sahai V, Griffith KA, et al. Phase 2 trial of neoadjuvant FOLFIRINOX and intensity modulated radiation therapy concurrent with fixed-dose rate-gemcitabine in patients with borderline resectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2020 Jan 1;106(1):124–133. doi:10.1016/j.ijrobp.2019.08.057. Epub 2019 Sep 5.
  1. Katz MHG, Shi Q, Meyers JP, et al. Alliance A021501: Preoperative mFOLFIRINOX or mFOLFIRINOX plus hypofractionated radiation therapy (RT) for borderline resectable (BR) adenocarcinoma of the pancreas. Journal of Clinical Oncology 2021;39(3) Suppl. 377–377. doi: 10.1200/JCO.2021.39.3.
  2. Groot Koerkamp B, Janssen QP, van Dam JL, et al. LBA83 Neoadjuvant chemotherapy with FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy for borderline resectable and resectable pancreatic cancer (PREOPANC-2): A multicenter randomized controlled trial. Annals of Oncology 2023;34, Suppl. 2. doi. org/10.1016/j.annonc.2023.10.084.
  3. Philip PA, Lacy J, Portales F, et al. Nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer (LAPACT): a multicentre, open-label phase 2 study. Lancet Gastroenterol Hepatol. 2020 Mar;5(3):285–294. doi: 10.1016/S2468-1253(19)30327-9.  Epub 2020 Jan 14.
  4. Suker M, Beumer BR, Sadot E, et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol. 2016 Jun;17(6):801–810. doi:10.1016/ S1470-2045(16)00172-8. Epub 2016 May 6.
  5. Chauffert B, Mornex F, Bonnetain F, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol. 2008 Sep;19(9):1592– 1599. doi:10.1093/annonc/mdn281. Epub 2008 May 7.
  6. Loehrer PJ Sr, Feng Y, Cardenes H, et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2011 Nov 1;29(31):4105–4112. doi:10.1200/JCO.2011.34.8904. Epub 2011 Oct 3.
  7. Hammel P, Huguet F, van Laethem JL, et al. LAP07 Trial Group. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: The LAP07 randomized clinical trial. JAMA 2016 May 3;315(17):1844–1853. doi:10.1001/jama.2016.4324.
  8. Hingorani SR, Zheng L, Bullock AJ, et al. HALO 202: Randomized phase II study of PEGPH20 plus nab-paclitaxel/gemcitabine versus nab-paclitaxel/gemcitabine in patients with untreated, metastatic pancreatic ductal adenocarcinoma. J Clin Oncol. 2018 Feb 1;36(4):359–366. doi:10.1200/JCO.2017.74.9564. Epub 2017 Dec 12.
  9. Ramanathan RK, McDonough SL, Philip PA, et al. Phase IB/II randomized study of FOLFIRINOX plus pegylated recombinant human hyaluronidase versus FOLFIRINOX alone in patients with metastatic pancreatic adenocarcinoma: SWOG S1313. J Clin Oncol. 2019 May 1;37(13):1062–1069. doi:10.1200/JCO.18.01295.  Epub  2019 Feb 28.
  10. Van Cutsem E, Tempero MA, Sigal D, et al. HALO 109-301 investigators. Randomized phase III trial of pegvorhyaluronidase alfa with nab-paclitaxel plus gemcitabine for patients with hyaluronan-high metastatic pancreatic adenocarcinoma. J Clin Oncol. 2020 Sep 20;38(27):3185–3194. doi:10.1200/JCO.20.00590. Epub 2020 Jul 24.
  11. O‘Reilly EM, Lee JW, Zalupski M, et al. Randomized, multicenter, phase II trial of gemcitabine and cisplatin with or without veliparib in patients with pancreas adenocarcinoma and a germline BRCA/ PALB2 mutation. J Clin Oncol. 2020 May  1;38(13):1378–1388.  doi:10.1200/JCO.19.02931. Epub 2020 Jan 24.
  12. Tempero M, Oh DY, Tabernero J, et al. Ibrutinib in combination with nab-paclitaxel and gemcitabine for first-line treatment of patients with metastatic pancreatic adenocarcinoma: phase III RESOLVE study. Ann Oncol. 2021 Feb 1: S09237534(21)00098-3. doi:10.1016/j.annonc.2021.01.070. Epub ahead of print.
  13. Hecht JR, Lonardi S, Bendell J, et al. Randomized phase III study of FOLFOX alone or with pegilodecakin as second-line therapy in patients with metastatic pancreatic cancer that progressed after gemcitabine (SEQUOIA). J Clin Oncol. 2021 Feb 8: JCO2002232. doi:10.1200/JCO.20.02232. Epub ahead of print.
  14. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997 Jun;15(6):2403–2413. doi:10.1200/JCO.1997.15.6.2403.
  15. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011 May 12;364(19):1817–1825. doi:10.1056/NEJMoa1011923.
  16. Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013 Oct 31;369(18):1691–1703. doi:10.1056/NEJMoa1304369. Epub 2013 Oct 16.
  17. Wainberg ZA, Melisi D, Macarulla T, et al. NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial. Lancet 2023 Oct 7;402(10409):1272–1281.  doi:10.1016/S0140-6736(23)01366-1. Epub 2023 Sep 11.
  18. Golan T, Hammel P, Reni M, et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. N Engl J Med. 2019 Jul 25;381(4):317–327. doi:10.1056/NEJMoa1903387. Epub 2019 Jun 2.
  19. Oettle H, Riess H, Stieler JM, et al. Second-line oxaliplatin, folinic acid, and fluorouracil versus folinic acid and fluorouracil alone for gemcitabine-refractory pancreatic cancer: outcomes from the CONKO-003 trial. J Clin Oncol. 2014 Aug 10;32(23):2423–2429. doi:10.1200/JCO.2013.53.6995. Epub 2014 Jun 30.
  20. Gill S, Ko YJ, Cripps C, et al. PANCREOX: A randomized phase III study of fluorouracil/leucovorin with or without oxaliplatin for second-line advanced pancreatic cancer in patients who have received gemcitabine-based chemotherapy. J Clin Oncol. 2016 Nov 10;34(32):3914–3920. doi:10.1200/JCO.2016.68.5776. Epub 2016 Sep 30.
  21. Wang-Gillam A, Li CP, Bodoky G, et al. NAPOLI-1 study group. 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 2016 Feb 6;387(10018):545–557. doi:10.1016/ S0140-6736(15)00986-1. Epub 2015 Nov 29. Erratum in: Lancet 2016 Feb 6;387 (10018):536.

MUDr. Marián Liberko
Onkologická klinika FNKV a 3. LF UK
Šrobárova 1 150/50,
100 34 Praha 10
e-mail: marian.liberko@fnkv.cz
ORCID: 0000-0001-8338-1555

Štítky
Surgery Orthopaedics Trauma surgery
Článek Ductal adenocarcinoma of the pancreas, a significant advance in treatment?
Článek Imaging methods in the diagnosis and treatment of pancreatic cancer
Článek Minimal invasive surgery of pancreatic cancer at the Department of Surgery of Masaryk university hospital Brno, Czech Republic
Článek Pancreatic surgery at the University Hospital Kralovske Vinohrady: 10-year review with a survival analysis for pancreatic ductal adenocarcinoma
Článek Meckel‘s diverticulum as a cause of gastrointestinal bleeding in an adolescent patient
Článok vyšiel v časopise

Perspectives in Surgery

Číslo 4
2024 Číslo 4
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#