Prognostic and predictive factors in pancreatic cancer

Abstract

Pancreatic cancer is one of the leading causes of cancer death worldwide. Its high mortality rate has remained unchanged for years. Radiotherapy and surgery are considered standard treatments in early and locally advanced stages. Chemotherapy is the only option for metastatic patients. Two treatment regimens, i. e. the association of 5-fluorouracil-irinotecan-oxaliplatin (FOLFIRINOX) and the association of nabpaclitaxel with gemcitabine, have been shown to improve outcomes for metastatic pancreatic adenocarcinoma patients. However, there are not standardized predictive biomarkers able to identify patients who benefit most from treatments. CA19-9 is the most studied prognostic biomarker, its predictive role remains unclear. Other clinical, histological and molecular biomarkers are emerging in prognostic and predictive settings. The aim of this review is to provide an overview of prognostic and predictive markers used in clinical practice and to explore the most promising fields of research in terms of treatment selection and tailored therapy in pancreatic cancer.

Association between neutropenia and survival to nab-paclitaxel and gemcitabine in patients with metastatic pancreatic cancer

“…Also, we evaluated only patients treated with Nab-Gem and metastatic disease whereas Chen et al investigated www.nature.com/scientificreports/ patients with locally advanced disease who received either gemcitabine monotherapy or other gemcitabine-based chemotherapy regimens. The prognostic role of neutropenia might be explained in multiple ways: firstly, systemic inflammation actively supports tumour initiation, promotion and progression; secondly, myelosuppression in severe neutropenic patients might lead to a significant reduction of myeloid-derived suppressing cells (MDSCs), resulting in the suppression of CD4+ T cells action against late-stage malignancies 22 . www.nature.com/scientificreports/ The correlation between neutropenia and taxanes efficacy has been previously demonstrated.…”

“…The prognostic role of neutropenia might be explained in multiple ways: firstly, systemic inflammation actively supports tumour initiation, promotion and progression; secondly, myelosuppression in severe neutropenic patients might lead to a significant reduction of myeloid-derived suppressing cells (MDSCs), resulting in the suppression of CD4+ T cells action against late-stage malignancies 22 .…”

Complementary Use of Carbohydrate Antigens Lewis a, Lewis b, and Sialyl-Lewis a (CA19.9 Epitope) in Gastrointestinal Cancers: Biological Rationale towards a Personalized Clinical Application

“…The outcome of gastrointestinal cancers, in particular pancreatic ductal adenocarcinoma (PDAC), is unfavorable when recognized at an advanced stage. The search for suitable biomarkers for the diagnosis, management and follow-up of gastrointestinal cancers is a relevant challenge of cancer research [1][2][3][4]. For several years, carbohydrate antigen 19.9 (CA19.9) has been widely used to address these aims in both research and clinical practice.…”

“…Glycosyltransferases are named according to the HUGO recommendations 2. Lea, Lewis a antigen;3 Leb, Lewis b antigen 4. PDAC, pancreatic ductal adenocarcinoma 5.…”

Prognostic Implications of 18-FDG Positron Emission Tomography/Computed Tomography in Resectable Pancreatic Cancer

“…Many circulating, molecular and clinicopathological factors have been thoroughly investigated in efforts to predict the survival of patients with pancreatic cancer [ 8 ]. Attention has focused especially on tumor stage and pathological grade [ 9 , 10 ], resection margins [ 11 ], preoperative serum CA 19-9 levels, postoperative normalization of tumor markers [ 12 , 13 ], and the demonstration of disseminated tumor cells [ 14 ].…”