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World J Gastroenterol. Mar 7, 2014; 20(9): 2352-2357
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2352
Optimum chemotherapy in the management of metastatic pancreatic cancer
Marwan Ghosn, Hampig Raphael Kourie, Fadi El Karak, Colette Hanna, Joelle Antoun, Dolly Nasr
Marwan Ghosn, Hampig Raphael Kourie, Fadi El Karak, Colette Hanna, Joelle Antoun, Dolly Nasr, Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon
Author contributions: Ghosn M initiated the review; Ghosn M and Kourie HR performed the review and wrote and analyzed the data; Ghosn M, Kourie HR, El Karak F, Hanna C, Antoun J, and Nasr D reviewed and commented on the paper and provided final approval.
Correspondence to: Marwan Ghosn, MD, Department of Oncology, Faculty of Medicine, Saint Joseph University, Monot St, Beirut 166830, Lebanon. mghosn.hdf@usj.edu.lb
Telephone: +961-1-3226842 Fax: +961-1-1613397
Received: October 28, 2013
Revised: January 3, 2014
Accepted: January 14, 2014
Published online: March 7, 2014
Processing time: 128 Days and 17.2 Hours
Abstract

Pancreatic cancer is one of the most devastating solid tumors, and it remains one of the most difficult to treat. The treatment of metastatic pancreatic cancer (MPC) is systemic, based on chemotherapy or best supportive care, depending on the performance status of the patient. Two chemotherapeutical regimens have produced substantial benefits in the treatment of MPC: gemcitabine in 1997; and FOLFIRIONOX in 2011. FOLFIRINOX improved the natural history of MPC, with overall survival (OS) of 11.1 mo. Nab-paclitaxel associated with gemcitabine is a newly approved regimen for MPC, with a median OS of 8.6 mo. Despite multiple trials, this targeted therapy was not efficient in the treatment of MPC. Many new molecules targeting the proliferation and survival pathways, immune response, oncofetal signaling and the epigenetic changes are currently undergoing phase I and II trials for the treatment of MPC, with many promising results.

Keywords: Metastatic pancreatic cancer; Chemotherapy; Evolution; Recent therapies; Targeted therapy

Core tip: This paper will be the newest study with the most recent updates in the treatment of metastatic pancreatic cancer. After a brief review of the different treatments for metastatic pancreatic cancer, the current treatment options are discussed, as well as novel therapies and approaches in the future.