Update on the management of pancreatic cancer:Surgery is not enough

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 11; pp. 3157 - 3165
• Main Authors: Ansari, Daniel, Gustafsson, Adam, Andersson, Roland
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.03.2015
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - blood; Biomarkers, Tumor - genetics; cancer;Diagnosis;Genetics;Epigenetics;P; Carcinoma, Pancreatic Ductal - blood; Carcinoma, Pancreatic Ductal - genetics; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Carcinoma, Pancreatic Ductal - therapy; Chemotherapy, Adjuvant; Clinical Medicine; Early Detection of Cancer; Gastroenterologi; Gastroenterologi och hepatologi; Gastroenterology and Hepatology; Humans; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Molecular Targeted Therapy; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Neoplasm Recurrence, Local; Neoplasm, Residual; Pancreatectomy - adverse effects; Pancreatic; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Patient Selection; Precision Medicine; Predictive Value of Tests; Risk Factors; Time Factors; Treatment Outcome; Chemotherapy; Pancreatic cancer; Surgery; Proteomics; Epigenetics; Stroma; Genetics; Diagnosis; Prognostic models
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v21.i11.3157

Pancreatic ductal adenocarcinoma(PDAC) represents the fourth cause of death in cancer and has a 5-year survival of < 5%.Only about 15% of the patients present with a resectable PDAC with potential to undergo "curative" surgery.After surgery,local and systemic recurrence,is though very common.The median survival of resected patients with adjuvant chemotherapy after surgery is only 20-23 mo.This underscores the significant need to improve PDAC management strategies.Increased survival rate is dependent on new breakthroughs in our understanding of not at least tumor biology.The aim of this review is to update and comment on recent knowledge concerning PDAC biology and new diagnostics and treatment modalities.One fundamental approach to improve survival rates is by earlier and improved diagnosis of the disease.In recent years,novel blood-based biomarkers have emerged based on genetic,epigenetic and protein changes in PDAC with very promising results.For biomarkers to enter clinical practice they need to have been developed using adequate control groups and provide high sensitivity and specificity and by this identify patients at risk already in a pre-symptomatic stage.Another way to improve outcomes,is by employing neoadjuvant treatments thereby increasing the number of resectable cases.Novel systemic treatment regimes like FOLFIRINOX and nab-paclitaxel have demonstrated improvements in prolonging survival in advanced cases,but long-term survival is still scarce.The future improved understanding of PDAC biology will inevitably render new treatment options directed against both the cancer cells and the surrounding microenvironment.