Recent Developments and Current Issues in the Treatment of Pancreatic Cancer

Abstract

Presently, many questions exist about what the optimal regimen comprises for all stages and treatment settings for pancreatic cancer. Since the CONKO-001 trial, adjuvant therapy following resection has become standard of care; however, outcomes are poor, with most patients experiencing disease recurrence, and new therapies have yet to be validated. Furthermore, the value of adjuvant radiotherapy has still not been clearly defined. Targeted treatment in combination with chemotherapy has been mostly disappointing so far in the adjuvant setting but immunotherapy holds potential for improving survival outcomes. Neoadjuvant treatment does not appear to provide much benefit in resectable patients but in the small subgroup of patients with borderline resectable/unresectable locally advanced disease it may increase the possibility of an R0 resection and, consequently, a substantial increase in survival duration. Use of capecitabine-based radiotherapy in patients with unresectable locally advanced disease appears to be more efficacious and better tolerated than gemcitabine-based chemoradiotherapy, with respect to survival outcomes. However, as with adjuvant treatment, the benefit of adding radiotherapy has not yet been definitively demonstrated. In patients with metastatic pancreatic cancer, targeting the stroma with nab-paclitaxel has shown promising results in a phase III trial setting when administered in combination with gemcitabine and, furthermore, this regimen is suitable for a broad range of patients due to its generally good tolerability profile. Because of its high toxicity, FOLFIRINOX is more suitable for younger patients with an excellent performance status who can withstand aggressive treatment and in patients with a worse performance status, gemcitabine monotherapy is considered to be a more appropriate treatment. Alternatively, gemcitabine in combination with erlotinib, the only targeted compound that has resulted in significant albeit small improvements in survival in patients with advanced disease, could be selected. However, the benefit-risk profile of this regimen is only favorable in a strictly defined, small patient subgroup who develop a treatment-related rash. Finally, with the elucidation of prognostic and predictive markers, treatment is expected to become ever more individualized, leading to improved efficacy outcomes and less unnecessary toxicity.

Is Victory over Pancreatic Cancer Possible, with the Help of Tuned Non-Invasive Physiotherapy? A Case Study Says Yes

“…Rife compiled a lengthy list of his test results of lethal frequencies for pathogenic germs. Then he tried hard to pro- 1 Living nature is what is closely associated with living body biomolecules. It is said to ensure the organism's finality and its reactive behaviour to the medium conditions and events.…”

“…Within this legal frame-work, a very welcome cure can come about, even if one swallow does not make a summer: the occurrence of an individual cure of a pancreatic adenocarcinoma, obtained with the participation of a complementary non-invasive bio-electromagnetic treatment, certainly does not mean that this complementary treatment has an objective therapeutic effectiveness. But, at a time when the optimal treatment of pancreatic cancer raises many questions, as recalled by Oettle, (2013), [1], anything that can enable such a cure invites reflection. The average lifespan of the patients is 6 months after they were diagnosed, as Wolfgang has indicated, (2013), [2].…”