Chemotherapy in Pancreatic Ductal Adenocarcinoma

Abstract

AbstractPancreatic ductal adenocarcinoma (PDAC) can be divided into four groups: (1) resectable, (2) borderline, (3) locally advanced, and (4) disseminated. Resection followed by adjuvant chemotherapy remains the standard of care for resectable PDAC. All patients with resected PDAC should be offered six months of adjuvant chemotherapy in the absence of contraindications. The modified FOLFIRINOX (mFOLFIRINOX) is preferred in the absence of concerns for toxicity or tolerance. Alternatively, combination therapy with gemcitabine and capecitabine, monotherapy with gemcitabine alone or (Fluorouracil) plus folinic acid can be offered as adjuvant chemotherapy. Recently, there has been increasing interest in neoadjuvant treatment due to the inability of some patients from adjuvant chemotherapy and the possibility of early micrometastasis even in resectable and borderline resectable PDAC. Patients at high risk for positive surgical margins are not considered to be good candidates for an upfront resection but may be potentially downstaged and safely resected following neoadjuvant therapy. Recent clinical trials suggested that neoadjuvant chemotherapy with FOLFIRINOX, gemcitabine plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel), and S-1 might be useful. However, future confirmative prospective studies are required. Unfortunately, most PDAC patients are metastatic at their diagnosis. FOLFIRINOX and gemcitabine plus nab-paclitaxel are the first recommended chemotherapeutic drugs. FOLFIRINOX and gemcitabine plus nab-paclitaxel combination therapy has shown remarkable effects in patients with advanced PDAC with relatively good systemic conditions, bringing new hope in the treatment of advanced PDAC. In addition, new targeted treatments and immune treatments using cancer cell-specific targets, and new treatments for desmoplastic characteristics of PDAC tissues are being attempted.