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World J Gastroenterol. Aug 28, 2017; 23(32): 5875-5886
Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5875
Nano albumin bound-paclitaxel in pancreatic cancer: Current evidences and future directions
Guido Giordano, Massimo Pancione, Nunzio Olivieri, Pietro Parcesepe, Marianna Velocci, Tania Di Raimo, Luigi Coppola, Giuseppe Toffoli, Mario Rosario D’Andrea
Guido Giordano, Marianna Velocci, Tania Di Raimo, Mario Rosario D’Andrea, Medical Oncology Unit, San Filippo Neri Hospital, 00135 Roma, Italy
Guido Giordano, CRO Aviano National Cancer Institute, 33081 Aviano, Italy
Massimo Pancione, Department of Sciences and Technologies, University of Sannio, 82100 Benevento, Italy
Massimo Pancione, Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain
Nunzio Olivieri, Department of Biology, University of Naples, Federico II, Via Mezzocannone, 80134 Napoli, Italy
Pietro Parcesepe, Department of Pathology and Diagnostics, University of Verona Strada, 37134 Verona, Italy
Luigi Coppola, Anatomic Pathology Unit, San Filippo Neri, 00135 Roma, Italy
Giuseppe Toffoli, Experimental and Clinical Pharmacology Unit, CRO-National Cancer Institute Via F, 33081 Aviano (Pordenone), Italy
Author contributions: Giordano G and Olivieri N performed the literature research; Giordano G and Olivieri N wrote the paper; Giordano G, Olivieri N, Parcesepe P and Di Raimo T assessed figure and tables; Pancione M, Parcesepe P, Velocci M, Di Raimo T, Coppola L, Toffoli G and D’Andrea MR reviewed the paper; Giordano G supervised the project.
Conflict-of-interest statement: Giordano G discloses: advisor role for Celgene, Sanofi, Novartis; consultant for Celgene, expenses reimbursement from Celgene. All other authors disclose no conflict of interest. This article does not contain any studies with human or animal subjects performed by the any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guido Giordano, MD, Medical Oncology Unit, San Filippo Neri Hospital, ASL Roma 1, Via Giovanni Martinotti 20, 00135 Roma, Italy. giordano.guido81@gmail.com
Telephone: +39-6-33062437 Fax: +39-6-33062445
Received: March 29, 2017
Peer-review started: April 1, 2017
First decision: June 5, 2017
Revised: July 3, 2017
Accepted: August 1, 2017
Article in press: August 2, 2017
Published online: August 28, 2017
Processing time: 152 Days and 0.9 Hours
Abstract

Pancreatic cancer (PDAC) is an aggressive and chemoresistant disease, representing the fourth cause of cancer related deaths in western countries. Majority of patients have unresectable, locally advanced or metastatic disease at time of diagnosis and the 5-year survival rate in these conditions is extremely low. For more than a decade gemcitabine has been the cornerstone of metastatic PDAC treatment, although survival benefit was very poor. PDAC cells are surrounded by an intense desmoplastic reaction that may create a barrier to the drugs penetration within the tumor. Recently PDAC stroma has been addressed as a potential therapeutic target. Nano albumin bound (Nab)-paclitaxel is an innovative molecule depleting tumor stroma, through interaction between albumin and secreted protein acidic and rich in cysteine. Addition of nab-paclitaxel to gemcitabine has showed activity and efficacy in metastatic PDAC first-line treatment improving survival and overall response rate vs gemcitabine alone in the MPACT phase III study. This combination represents one of the standards of care in advanced PDAC therapy and is suitable to a broader spectrum of patients compared to other schedules. Nab-paclitaxel is under investigation as a backbone of chemotherapy in novel combinations with target agents or immunotherapy in locally advanced or metastatic PDAC. In this article, we provide an updated and critical overview about the role of nab-paclitaxel in PDAC treatment based on the latest advances in preclinical and clinical research. Furthermore, we focus on the use of nab-paclitaxel within the context of metastatic PDAC treatment landscape and we discuss about future implications in the light of current clinical ongoing trials.

Keywords: Nano albumin bound-paclitaxel; Pancreatic cancer; Metastatic disease; Gemcitabine; Folfirinox

Core tip: In this article, we provide an updated and critical overview about the role of nano albumin bound (Nab)-paclitaxel in pancreatic cancer (PDAC) treatment based on the latest advances in preclinical and clinical research. Furthermore, we focus on the use of Nab-paclitaxel within the context of metastatic PDAC treatment landscape and we discuss about future implications in the light of current clinical ongoing trials.