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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2017; 9(7): 281-292
Published online Jul 15, 2017. doi: 10.4251/wjgo.v9.i7.281
Evolving treatment landscape for early and advanced pancreatic cancer
Sally C Lau, Winson Y Cheung
Sally C Lau, Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada
Winson Y Cheung, Department of Oncology, University of Calgary, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada
Author contributions: Lau SC and Cheung WY wrote the paper; Cheung WY provided supervision and review.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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: Dr. Winson Y Cheung, Department of Oncology, University of Calgary, Tom Baker Cancer Center, 1331 29 ST NW, Calgary, AB T2N 4N2, Canada. wcheung@bccancer.bc.ca
Telephone: +1-403-5213565 Fax: +1-403-9442331
Received: January 28, 2017
Peer-review started: February 12, 2017
First decision: March 7, 2017
Revised: March 21, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: July 15, 2017
Processing time: 164 Days and 15.1 Hours
Abstract

Pancreatic ductal adenocarcinoma is an infrequent cancer with a high disease related mortality rate, even in the context of early stage disease. Until recently, the rate of death from pancreatic cancer has remained largely similar whereby gemcitabine monotherapy was the mainstay of systemic treatment for most stages of disease. With the discovery of active multi-agent chemotherapy regimens, namely FOLFIRINOX and gemcitabine plus nab-paclitaxel, the treatment landscape of pancreatic cancer is slowly evolving. FOLFIRINOX and gemcitabine plus nab-paclitaxel are now considered standard first line treatment options in metastatic pancreatic cancer. Studies are ongoing to investigate the utility of these same regimens in the adjuvant setting. The potential of these treatments to downstage disease is also being actively examined in the locally advanced context since neoadjuvant approaches may improve resection rates and surgical outcomes. As more emerging data become available, the management of pancreatic cancer is anticipated to change significantly in the coming years.

Keywords: Cancer; Neoplasm; Pancreas; Adjuvant treatment; Systemic treatment; Gemcitabine; FOLFIRINOX; Nab-paclitaxel

Core tip: Pancreatic ductal adenocarcinoma is an infrequent cancer with high disease mortality. The focus on management of the disease has been mainly palliation for the past decade. Recently, the discovery of active multi-agent chemotherapies such as FOLFIRINOX and gemcitabine plus nab-paclitaxel has changed the management of the disease. In our current review, we will highlight some of the advances, particularly with respect to systemic therapy options, in the management of different stages of pancreatic cancer.