Pancreatic cancer

Lancet. 2020 Jun 27;395(10242):2008-2020. doi: 10.1016/S0140-6736(20)30974-0.

Abstract

Pancreatic cancer is a highly fatal disease with a 5-year survival rate of approximately 10% in the USA, and it is becoming an increasingly common cause of cancer mortality. Risk factors for developing pancreatic cancer include family history, obesity, type 2 diabetes, and tobacco use. Patients typically present with advanced disease due to lack of or vague symptoms when the cancer is still localised. High quality computed tomography with intravenous contrast using a dual phase pancreatic protocol is typically the best method to detect a pancreatic tumour and to determine surgical resectability. Endoscopic ultrasound is an increasingly used complementary staging modality which also allows for diagnostic confirmation when combined with fine needle aspiration. Patients with pancreatic cancer are often divided into one of four categories based on extent of disease: resectable, borderline resectable, locally advanced, and metastatic; patient condition is also an important consideration. Surgical resection represents the only chance for cure, and advancements in adjuvant chemotherapy have improved long-term outcomes in these patients. Systemic chemotherapy combinations including FOLFIRINOX (5-fluorouracil, folinic acid [leucovorin], irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel remain the mainstay of treatment for patients with advanced disease. Data on the benefit of PARP inhibition as maintenance therapy in patients with germline BRCA1 or BRACA2 mutations might prove to be a harbinger of advancement in targeted therapy. Additional research efforts are focusing on modulating the pancreatic tumour microenvironment to enhance the efficacy of the immunotherapeutic strategies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Intravenous
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • BRCA1 Protein / drug effects
  • BRCA1 Protein / genetics
  • BRCA2 Protein / drug effects
  • BRCA2 Protein / genetics
  • Chemotherapy, Adjuvant / methods
  • Contrast Media / administration & dosage
  • DNA Damage / drug effects
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods
  • Humans
  • Immunotherapy / methods
  • Middle Aged
  • Mutation
  • Neoplasm Staging
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / epidemiology*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Risk Factors
  • Survival Rate
  • Tomography, X-Ray Computed / methods
  • Tumor Microenvironment / drug effects

Substances

  • BRCA1 Protein
  • BRCA1 protein, human
  • BRCA2 Protein
  • BRCA2 protein, human
  • Contrast Media