Metastatic pancreatic ductal adenocarcinoma: diagnosis and treatment with a view to the future

Intern Med J. 2018 Jun;48(6):637-644. doi: 10.1111/imj.13810.

Abstract

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a lethal disease with a poor 5-year survival. Systemic treatments can be used to control symptoms and prolong life. Cytotoxic chemotherapies are commonly administered, with combination treatments, such as fluorouracil, folinic acid, irinotecan and oxaliplatin (FOLFIRINOX) or nab-paclitaxel and gemcitabine showing the largest clinical benefits. Newer genomic classifications of PDAC may provide a rationale for targeted therapies or immunotherapies, although at present these remain largely experimental. This review discusses the evidence behind the currently used regimens, while introducing the potential future of pancreatic cancer care.

Keywords: adenocarcinoma; cancer genomics; clinical trials; cytotoxic chemotherapy; metastatic; pancreatic cancer.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / secondary
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma, Pancreatic Ductal / drug therapy*
  • Carcinoma, Pancreatic Ductal / secondary
  • Drug Combinations
  • Fluorouracil / therapeutic use
  • Humans
  • Immunotherapy / trends
  • Irinotecan
  • Leucovorin / therapeutic use
  • Organometallic Compounds / therapeutic use
  • Oxaliplatin
  • Pancreatic Neoplasms / drug therapy*
  • Pancreatic Neoplasms / pathology
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic

Substances

  • Drug Combinations
  • Organometallic Compounds
  • folfirinox
  • Oxaliplatin
  • Irinotecan
  • Leucovorin
  • Fluorouracil