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Systemic treatment for inoperable pancreatic adenocarcinoma: review and update
Stephen L Chan1, Sin T Chan, Eric H Chan
1State 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.
Abstract:
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.
Insights
For unresectable pancreatic cancer, gemcitabine monotherapy was standard. Novel regimens like FOLFIRINOX and gemcitabine-nab-paclitaxel now offer improved survival, with human equilibrative nucleotide transporter 1 as a potential biomarker.
Area of Science:
- Oncology
- Medical Research
- Clinical Trials
Background:
- Pancreatic cancer treatment has long relied on gemcitabine monotherapy due to numerous negative clinical trial outcomes for novel systemic regimens.
- Targeted agents against EGFR and VEGFR have been explored with limited success, highlighting the need for more effective therapies.
Purpose of the Study:
- To review the evolution of systemic agents for unresectable pancreatic cancer.
- To discuss current treatment options and emerging therapeutic strategies.
- To explore potential biomarkers for predicting treatment efficacy.
Main Methods:
- Literature review of clinical trials and research on systemic agents for pancreatic cancer.
- Analysis of recent breakthroughs in treatment regimens.
- Examination of emerging data on predictive biomarkers.
Main Results:
- Three regimens—gemcitabine-erlotinib, FOLFIRINOX, and gemcitabine-nab-paclitaxel—have demonstrated improved overall survival compared to gemcitabine monotherapy.
- Emerging evidence identifies human equilibrative nucleotide transporter 1 (hCNT1) as a potential biomarker for gemcitabine efficacy.
Conclusions:
- Recent advances have provided new effective systemic treatment options for unresectable pancreatic cancer.
- The identification of biomarkers like hCNT1 may personalize treatment strategies and improve outcomes.
- Future research should focus on developing novel agents and refining biomarker-driven approaches.
