Therapeutic options for the management of pancreatic cancer

Abstract

Since its initial characterization, pancreatic ductal adenocarcinoma has remained one of the most devastating and difficult cancers to treat. Pancreatic cancer is the fourth leading cause of death in the United States, resulting in an estimated 38460 deaths annually. With few screening tools available to detect this disease at an early stage, 94% of patients will die within five years of diagnosis. Despite decades of research that have led to a better understanding of the molecular and cellular signaling pathways in pancreatic cancer cells, few effective therapies have been developed to target these pathways. Other treatment options have included more sophisticated pancreatic cancer surgeries and combination therapies. While outcomes have improved modestly for these patients, more effective treatments are desperately needed. One of the greatest challenges in the future of treating this malignancy will be to develop therapies that target the tumor microenvironment and surrounding pancreatic cancer stem cells in addition to pancreatic cancer cells. Recent advances in targeting pancreatic stellate cells and the stroma have encouraged researchers to shift their focus to the role of desmoplasia in pancreatic cancer pathobiology in the hopes of developing newer-generation therapies. By combining novel agents with current cytotoxic chemotherapies and radiation therapy and personalizing them to each patient based on specific biomarkers, the goal of prolonging a patient’s life could be achieved. Here we review the most effective therapies that have been used for the treatment of pancreatic cancer and discuss the future potential of therapeutic options.

Keywords: Pancreatic cancer, Pancreatic cancer stem cells, Microenvironment, Surgical resection, Neoadjuvant therapy, Adjuvant therapy, Chemotherapy, Radiation, Personalized therapy

Core tip: Pancreatic ductal adenocarcinoma has challenged researchers for decades. It remains one of the most deadly cancers due to the complex molecular and genetic makeup of its cancer cells and their surrounding microenvironment. In addition, there are no valid screening tests available to detect pancreatic cancer in its early stages. Yet, as knowledge of this cancer has evolved over time, so have novel methods for treating it. Researchers have a deeper understanding of pancreatic cancer now than ever before. The future holds much promise for new breakthroughs that will significantly improve patient outcomes.