Chemotherapy in Pancreatic Cancer: A Systematic Review

Abstract

Background and Aim: Pancreatic cancer is one of the most fatal cancers. Cytotoxic chemotherapy remains the mainstream treatment for unresectable pancreatic cancer. This systematic review evaluated and compared the overall survival (OS) and progression-free survival (PFS) outcomes obtained from recent phase 2 and 3 clinical trials of pancreatic cancer chemotherapy. Materials and methods: Thirty-two studies were included and compared based on chemotherapy agents or combinations used. Additionally, outcomes of first-line versus second-line chemotherapy in pancreatic cancer were compared. Results: In studies that investigated the treatments in adjuvant settings, the highest OS reported was for S-1 in patients, who received prior surgical resection (46.5 months). In neoadjuvant settings, the combination of gemcitabine, docetaxel, and capecitabine prior to the surgical resection had promising outcomes (OS of 32.5 months). In non-adjuvant settings, the highest OS reported was for the combination of temsirolimus plus bevacizumab (34.0 months). Amongst studies that investigated second-line treatment, the highest OS reported was for the combination of gemcitabine plus cisplatin (35.5 months), then temsirolimus plus bevacizumab (34.0 months). Conclusions: There is a need to develop further strategies besides chemotherapy to improve the outcomes in pancreatic cancer treatment. Future studies should consider surgical interventions, combination chemotherapy, and individualized second-line treatment based on the prior chemotherapy.

Novel therapeutic approaches for pancreatic cancer by combined targeting of RAF→MEK→ERK signaling and autophagy survival response

“…Lack of efficiency of current therapy in the treatment of pancreatic cancer PDAC is the epitome of a treatment-resistant malignancy, driven by a so far "undruggable" oncoprotein, KRAS (20,21). Pancreatic cancer is a major cause of cancerassociated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades.…”

“…Palliative gemcitabine has been the standard treatment for pancreatic cancer for many years with a modest survival benefit of about 3 months. At present the first-line therapy in pancreatic cancer includes FOLFIRINOX (made up of: folinic acid, 5-fluorouracil, irinotecan and oxaliplatin) and nabpaclitaxel plus gemcitabine, whereas combinations of gemcitabine plus cisplatin and temsirolimus plus bevacizumab are used for second-line treatment, but in all cases the survival outcomes of pancreatic cancer remain poor (21,23). Thus, PDAC remains one of the most lethal malignancies with a gloomy prognosis, and therefore new therapeutic drugs and approaches are urgently needed.…”

Pectin-Tannic Acid Nano-Complexes Promote the Delivery and Bioactivity of Drugs in Pancreatic Cancer Cells

“…It is typically diagnosed at a later stage, so surgery becomes difficult to perform, and chemotherapy is a suitable option. 5-Flurouracil (5-FU), gemcitabine (GEM), and irinotecan (IRI) are some of the FDA approved mono or combination chemotherapeutics for PanCa [3][4][5]. However, conventional chemotherapies are often associated with numerous systemic side effects and lead to drug resistance, which results in low therapeutic benefit(s).…”

microRNA-26a Inhibits the Malignant Tumor Behavior of Pancreatic Cancer Cells via Targeting E2F7

“…PCa is one of the highly lethal malignancies with extremely low 5-year survival rate (37)(38)(39)(40).…”