Pancreatic cancer: treatment approaches and trends

Abstract

Pancreatic cancer is one of the most challenging diseases due to its often late diagnose which results in limited therapeutic options and poor prognosis. To date, the only curative treatment is complete tumor removal surgery but only a few patients are eligible to do it. The median survival period after surgery followed by chemotherapy adjuvant treatment is about 2 years. Since its approval by the FDA, Gemcitabine has become the first-line chemotherapy agent for treatment of advanced pancreatic cancer. The FOLFIRINOX regimen is also used as a treatment scheme for pancreatic cancer; however, this regimen has resulted in small improvements in overall patient's survival. It is appropriated to clarify that the FOLFIRINOX regimen can only be administered in patients with good performance status. Due to the absence of outstanding result after patient's treatment with diverse chemotherapeutic agents combinations or unsuccessful administration of single-agent drugs to treat pancreatic cancer, the immunotherapy has become a new hope. A more comprehensive understanding of cancer microenvironment and the chemical communication between cancer cells and immune cells can result in new therapeutic approaches that will improve the elimination of pancreatic cancer cells, enhancing life quality for these patients and increasing the overall survival.

The role of immunogenic cell death in gastrointestinal cancer immunotherapy (Review)

“…PC is the 14th most prevalent type of cancer and the seventh largest cause of annual cancer-associated deaths globally. PC risk factors include obesity, alcohol consumption and smoking, as well as H. pylori infection ( 20 ).…”

Classic adrenal adenoma undergoing necrosis secondary to chemotherapy for pancreatic adenocarcinoma

“…These agents are known to cause tumour cell necrosis, although necrosis of an adrenal adenoma potentially attributed to the use of this regimen has not been described. 5‐fluorouracil (5‐FU) is a pyrimidine analogue which inhibits thymidylate synthase, thus impairing deoxythymidine monophosphate production which is an essential component of DNA replication 5 . 5‐FU also incorporates its metabolites into RNA and DNA resulting in cytotoxicity and cell death 5 .…”

“…5‐fluorouracil (5‐FU) is a pyrimidine analogue which inhibits thymidylate synthase, thus impairing deoxythymidine monophosphate production which is an essential component of DNA replication 5 . 5‐FU also incorporates its metabolites into RNA and DNA resulting in cytotoxicity and cell death 5 . Leucovorin is a folic acid derivative that enhances the therapeutic effect of 5‐FU by increasing the binding affinity of 5‐FU to thymidylate synthase 6 .…”

Cold Atmospheric Plasma Treatment for Pancreatic Cancer–The Importance of Pancreatic Stellate Cells

“…FOLFIRINOX is a combination of oxaliplatin, fluorouracil (5-FU), irinotecan and leucovorin, and works on quickly dividing cells [ 77 , 134 ]. The mechanisms of actions have been clearly described in a review by Pereira et al [ 135 ]: 5-FU is an anti-metabolite that inhibits the synthesis of thymine and DNA synthesis. Leucovorin is a metabolite that reduces the adverse toxicity effects of 5-FU and contributes to prolonging the survival rates.…”