Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

Franck, Caspar; Müller, Christian; Rosania, Rosa; Croner, Roland S.; Pech, Maciej; Venerito, Marino

doi:10.3390/cancers12071955

Cited by 29 publications

(29 citation statements)

References 84 publications

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“…Currently, the only potentially curative option for PDAC is surgical resection with negative margins, but only a small number of patients have operable tumors. [ 17 ] The characteristics of PDAC include fast growth and rapid metastasis to other organs. Early detection of PDAC is a key factor in increasing the number of patients eligible for surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer

Kim¹,

Cho²,

Park³

2021

Medicine

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Rationale: Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears. Patient concerns: A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever. Diagnoses: The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN. Interventions and outcomes: EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy. Lessons: In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.

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Section: Discussionmentioning

confidence: 99%

Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer

Kim¹,

Cho²,

Park³

2021

Medicine

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“…Применение другого ингибитора PARP, олапариба, было одобрено в США и в ряде других стран в 2019 г. в качестве 1-й линии поддерживающей терапии у пациентов с метастатическим РПЖ с герминальными мутациями в генах BRCA 1 / 2 на основании результатов исследования фазы III POLO. В исследовании было показано, что терапия олапарибом почти в 2 раза увеличивает медиану выживаемости без прогрессирования у пациентов с герминальными мутациями в генах BRCA 1 / 2 -до 7,4 мес по сравнению с 3,8 мес на фоне плацебо [59,60].…”

Section: обзоры литературыunclassified

Pancreatic Cancer, Current Therapeutic Approaches and Possible Prospects

Bykova

Фалалеева

Гривцова

2020

Rossijskij bioterapevtičeskij žurnal

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Prevalence of pancreatic cancer (PC) is not high in the population, but the aggressive nature of the disease leads to the fact that PC is one of the main causes of death in a group of patients with cancer. The prognosis for PC is significantly worse in the case of metastatic spread. It is proved that pancreatic adenocarcinoma from the very beginning is a systemic disease with early micrometastatic spread, so the question of effective drug treatment is extremely relevant. Chemotherapy is the basis for the treatment of patients with metastatic prostate cancer. However, despite numerous clinical studies using known cytostatic and targeted agents, progress in the treatment of this disease remains relatively modest compared to the progress made in the treatment of other types of tumors. The complexities of prostate cancer therapy are explained by the presence of a dense connective tissue tumor stroma, which is not just a barrier to tumor cells. It has a significant impact on various vital cellular processes, including tumor formation, invasion, metastasis, and contributes to the formation of drug resistance. Pancreatic cancer is heterogeneous in terms of molecular and biological characteristics. Many genetic changes, including germ lines and somatic mutations, contribute to the development of this disease. Recent studies have shown that each sample of prostate cancer includes an average of 63 genetic changes and 12 major signalling pathways. Further studies of tumor microenvironment markers and decoding the heterogeneity of the tumor genome in PC should become the basis for a “personalized” approach to treatment. It is likely 19 4'2020 ТОм 19 vol. 19 РОССИЙСКИЙ БИОТЕРАПЕВТИЧЕСКИЙ ЖУРНАЛ Russian journal of biotherapy Обзоры литературы that in the future, the integration of traditional chemotherapeutic treatments and an immunological approach will be the key to effective treatment of this deadly disease.

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“…7,8 A modified FOLFIRINOX regimen (mFOLFIRINOX; no or decreased administration of bolus 5-fluorouracil plus decreased irinotecan administration) has been shown to exhibit improved safety with maintained efficacy. 9,10 Although there have been no direct, prospective, randomized comparisons between the original FOLFIRINOX regimen and mFOLFIRINOX, this modified regimen is thought to be equivalent to the original FOLFIRINOX regimen for the palliative treatment of PC. [10][11][12] Second-line chemotherapy can improve the survival of patients with metastatic pancreatic cancer (MPC) after failure offirst-line GEM-based chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Although there have been no direct, prospective, randomized comparisons between the original FOLFIRINOX regimen and mFOLFIRINOX, this modified regimen is thought to be equivalent to the original FOLFIRINOX regimen for the palliative treatment of PC. [10][11][12] Second-line chemotherapy can improve the survival of patients with metastatic pancreatic cancer (MPC) after failure offirst-line GEM-based chemotherapy. [13][14][15][16] Although several previous phase III studies demonstrated survival benefit with their study regimens, [14][15][16] the standard treatment remains to be established.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of modified fluorouracil/leucovorin plus irinotecan and oxaliplatin (mFOLFIRINOX) compared with S‐1 as second‐line chemotherapy in metastatic pancreatic cancer

et al. 2021

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Background and Aim: The optimal standard second-line chemotherapy for metastatic pancreatic cancer (MPC) remains unclear. Here, we evaluated the efficacy and safety of modified fluorouracil/leucovorin plus irinotecan and oxaliplatin (mFOLFIRINOX) compared with oral fluoropyrimidine S-1 as a second-line chemotherapy in patients with MPC. Methods: We retrospectively reviewed 76 consecutive patients with metastatic pancreatic adenocarcinoma who underwent mFOLFIRINOX or S-1 treatment as a second-line chemotherapy after gemcitabine plus nab-paclitaxel (GnP) failure at our department between December 2014 and February 2019. Results: Patients who underwent mFOLFIRINOX treatment exhibited significantly better objective response rates (ORRs) and progression-free survival (PFS) than S-1 (ORR, 20.0% vs 0%, P = 0.003; PFS, 3.7 vs 2.1 months, P = 0.010). Although baseline patient characteristics of age, performance status, and serum albumin levels differed significantly between the two groups, mFOLFIRINOX was identified as an independent factor of favorable PFS on multivariate analyses. Grade 3-4 neutropenia and peripheral sensory neuropathy occurred more frequently in the mFOLFIRINOX group. The median overall survival from the initiation of second-line chemotherapy was not significantly longer in the mFOLFIRINOX group than in the S1 group (8.5 vs 5.8 months, respectively; P = 0.213); however, the 8-month survival rate was significantly higher in the mFOLFIRINOX group (56.0% vs 27.5%, respectively; P = 0.030). Conclusions: mFOLFIRINOX as a second-line regimen contributed to favorable treatment outcomes, but induced more frequent adverse events than S-1. On multivariate analyses, mFOLFIRINOX was identified as an independent factor with favorable PFS, suggesting that mFOLFIRINOX could be a promising treatment option for patients with GnP failure.

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Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

Cited by 29 publications

References 84 publications

Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer

Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer

Pancreatic Cancer, Current Therapeutic Approaches and Possible Prospects

Efficacy and safety of modified fluorouracil/leucovorin plus irinotecan and oxaliplatin (mFOLFIRINOX) compared with S‐1 as second‐line chemotherapy in metastatic pancreatic cancer

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