Chemotherapy for pancreatic cancer

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Pancreatic cancer treatment relies on multimodality approaches, with chemotherapy being crucial.
• Adjuvant chemotherapy significantly enhances disease-free and overall survival after curative resection.
• Established chemotherapy regimens include mFOLFIRINOX and gemcitabine-based combinations for metastatic disease.

Purpose of the Study:

• To review current chemotherapy standards and emerging therapies for pancreatic cancer.
• To evaluate the role of adjuvant, neoadjuvant, and palliative chemotherapy.
• To discuss the potential of novel local therapies and personalized treatment strategies.

Main Methods:

• Review of current clinical practice guidelines and landmark studies (e.g., ESPAC-4, LAP07).
• Analysis of chemotherapy regimens: mFOLFIRINOX, gemcitabine/capecitabine, gemcitabine/nab-paclitaxel.
• Exploration of investigational local therapies and molecularly targeted approaches.

Main Results:

• mFOLFIRINOX and gemcitabine/capecitabine are standards for adjuvant therapy.
• Combination chemotherapy (mFOLFIRINOX, gemcitabine/nab-paclitaxel) improves outcomes in metastatic pancreatic cancer.
• Chemoradiation's role in locally advanced disease is under re-evaluation; local therapies are under investigation.

Conclusions:

• Systemic chemotherapy remains central to pancreatic cancer management, both in adjuvant and metastatic settings.
• Personalized treatment selection based on molecular signatures and organoid models shows future promise.
• While local therapies are being explored, their efficacy is likely limited by the systemic nature of pancreatic cancer.