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Pancreatic Cancer: A Review
Wungki Park1,2,3,4, Akhil Chawla5,6, Eileen M O'Reilly1,2,3
1Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA
|September 21, 2021
Summary
Pancreatic cancer (PDAC) is increasing and often diagnosed at advanced stages. Multidisciplinary care, germline testing, and supportive care are crucial for improving outcomes in pancreatic cancer patients.
Area of Science:
- Oncology
- Gastroenterology
Background:
- Pancreatic ductal adenocarcinoma (PDAC) incidence is rising, projected to be the second leading cause of cancer mortality by 2030.
- Most PDAC patients present with locally advanced or metastatic disease due to lack of effective screening.
- PDAC management requires a multidisciplinary approach, considering disease stage and vascular involvement.
Purpose of the Study:
- To outline current therapeutic strategies for pancreatic ductal adenocarcinoma (PDAC).
- To highlight the importance of multidisciplinary management and germline testing in PDAC.
- To review treatment options based on disease resectability and patient characteristics.
Main Methods:
- Review of standard therapeutic approaches for resectable, borderline resectable, and advanced PDAC.
- Analysis of survival data for various chemotherapy regimens (e.g., FOLFIRINOX, gemcitabine/nab-paclitaxel) and targeted therapy (olaparib).
- Emphasis on neoadjuvant therapy, adjuvant chemotherapy, and systemic therapy combined with radiation.
Main Results:
- Surgery followed by adjuvant FOLFIRINOX improves survival in resectable PDAC compared to gemcitabine.
- Systemic therapies offer a modest survival benefit (2-6 months) for advanced PDAC.
- Olaparib improves progression-free survival in metastatic PDAC patients with BRCA mutations.
Conclusions:
- Multidisciplinary management, comprehensive germline testing, and integrated supportive care are recommended for all PDAC patients.
- Treatment strategies should be tailored to disease stage, vascular involvement, and specific genetic profiles.
- Advances in systemic and targeted therapies are improving outcomes for advanced pancreatic cancer.
