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Pharmacotherapeutic options for pancreatic ductal adenocarcinoma
Muhammad Sardar1, Alejandro Recio-Boiles1, Kabir Mody2
1Division of Hematology-Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, Az, USA.
Introduction:
Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy projected to be the 2nd leading cause of cancer related death in the USA by 2030. This manuscript discusses current and evolving treatment approaches in patients with pancreatic cancer.
Areas Covered:
PDAC is classified as: a) resectable, b) borderline resectable, c) unresectable (locally advanced and metastatic). The standard of care for patients who present with resectable pancreatic adenocarcinoma is six months of adjuvant modified (m) FOLFIRINOX, gemcitabine plus capecitabine, or single agent gemcitabine. For many reasons, there has been a paradigm shift to employing neoadjuvant chemotherapy. For resectable and borderline resectable patients, we generally start with systemic therapy and reevaluate resectability with subsequent scans specifically when the tumor is located in the head or body of the pancreas. Combined chemoradiation therapy can be employed in select patients. The standard of care for metastatic PDAC is FOLFIRINOX or gemcitabine and nab-paclitaxel. Germline and somatic genomic profiling should be obtained in all patients. Patients with a germline BRCA mutation can receive upfront gemcitabine and cisplatin.
Expert Opinion:
Thorough understanding of molecular pathogenesis in PDAC has opened various therapeutic avenues. We remain optimistic that future treatment modalities such as targeted therapies, cellular therapies and immunotherapy will further improve survival in PDAC.
Insights
Pancreatic cancer treatment is evolving, with neoadjuvant chemotherapy becoming standard for resectable and borderline cases. Genomic profiling guides therapy, especially for BRCA mutations, improving outcomes for pancreatic ductal adenocarcinoma (PDAC).
Area of Science:
- Oncology
- Gastroenterology
- Cancer Research
Background:
- Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death, projected to be the second leading cause in the USA by 2030.
- Understanding PDAC's molecular pathogenesis is crucial for developing effective treatment strategies.
Purpose of the Study:
- To discuss current and evolving treatment approaches for pancreatic cancer.
- To highlight the shift towards neoadjuvant chemotherapy and the importance of genomic profiling.
Main Methods:
- Review of standard-of-care treatments for resectable, borderline resectable, and metastatic PDAC.
- Discussion of neoadjuvant chemotherapy, adjuvant therapy, and targeted treatments.
- Emphasis on germline and somatic genomic profiling for personalized therapy.
Main Results:
- Standard adjuvant therapy for resectable PDAC includes mFOLFIRINOX, gemcitabine/capecitabine, or gemcitabine.
- Neoadjuvant chemotherapy is increasingly employed for resectable and borderline cases, with re-evaluation of resectability after systemic therapy.
- FOLFIRINOX or gemcitabine/nab-paclitaxel are standards for metastatic PDAC.
- Germline BRCA mutations warrant upfront gemcitabine and cisplatin treatment.
Conclusions:
- The treatment landscape for PDAC is shifting, with a growing emphasis on neoadjuvant systemic therapy and personalized treatment based on genomic profiling.
- Future advancements in targeted therapies, cellular therapies, and immunotherapy hold promise for improving survival rates in PDAC patients.
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