The Multidisciplinary Approach to Localized Pancreatic Adenocarcinoma

Abstract

Pancreatic adenocarcinoma 2030 (PCa) is predicted to be the second leading cause of cancer death in USA by 2030. To date, attempts at early detection have been unsuccessful. Therapies for resectable PCa include surgery followed by adjuvant chemotherapy with or without radiotherapy. Unfortunately, most patients with PCa present with advanced disease and thus only 20% of patients are potentially resectable upon presentation. Improved surgical techniques along with adjuvant combination chemotherapy have improved outcomes for patients with resectable disease. The optimal treatment approach for borderline resectable and locally advanced unresectable PCa has not yet been defined. Despite significant advances in the palliative treatment of PCa, long-term survival of early stage disease continues to be sobering. The key to improving outcomes for this largely fatal disease is to identify multidisciplinary therapeutic interventions including surgical, medical, and radiation techniques tailored to the patient and their disease characteristics. The neoadjuvant approach provides an in vivo platform to test novel treatment options to help us understand tumor biology and surrounding microenvironment, which may ultimately help us achieve the goal of improvement in long-term survival. While the neoadjuvant approach remains popular as a way to optimally select patients that might benefit most from surgery, randomized trials utilizing adjuvant and neoadjuvant novel therapies hold the key to truly personalizing the ideal treatment strategy for localized PCa.

Predictive Value of Preoperative Serum CA19-9 on Margin Status

“…12 In this multidisciplinary era, determination of resectability is vital. 13 Unfortunately, even in patients who meet the criteria and undergo curative resection, survival rates remain dismal. 14 Prognostic factors after resection have been widely studied.…”

KRT7 Overexpression is Associated with Poor Prognosis and Immune Cell Infiltration in Patients with Pancreatic Adenocarcinoma

“…As we all known, PAAD is the most common malignant tumor with high recurrence and poor prognosis. 1 Promising biomarkers of PAAD need to be identified for improvement of the diagnosis and therapy to reduce mortality. KRT7 is a member of the keratin gene family, which mainly plays a role in maintaining the structural integrity of epithelial cells.…”

“…Pancreatic adenocarcinoma (PAAD) is a deadly malignant tumor with a high recurrence rate and poor prognosis. 1 Most patients are diagnosed at an advanced stage, with local or systemic metastases. Only 15%-20% of patients are eligible for surgical resection, but metastasis and recurrence are also prone to occur after surgery.…”

Expanding the Spectrum of Pancreatic Cancers Responsive to Vesicular Stomatitis Virus-Based Oncolytic Virotherapy: Challenges and Solutions

“…Although several gemcitabine-based combination treatments exist, most have not considerably improved survival. While some combinatorial chemotherapy treatments, such as gemcitabine with erlotinib, have demonstrated potential for longer patient survival, the majority of patients eventually experience tumor progression due to the development of resistance, and therefore novel therapies are required, especially those that do not rely solely on chemotherapeutic drugs [17,18].…”