Abstract
Pancreatic cancer is one of the most lethal malignancies and is associated with a poor prognosis. Surgery is considered the only potential curative treatment for pancreatic cancer, followed by adjuvant chemotherapy, but surgery is reserved for the minority of patients with non-metastatic resectable tumors. In the future, neoadjuvant treatment strategies based on molecular testing of tumor biopsies may increase the amount of patients becoming eligible for surgery. In the context of non-metastatic disease, patients with resectable or borderline resectable pancreatic carcinoma might benefit from neoadjuvant chemo- or chemoradiotherapy followed by surgeryPatients with locally advanced or (oligo-/poly-)metastatic tumors presenting significant response to (neoadjuvant) chemotherapy should undergo surgery if R0 resection seems to be achievable. New immunotherapeutic strategies to induce potent immune response to the tumors and investigation in molecular mechanisms driving tumorigenesis of pancreatic cancer may provide novel therapeutic opportunities in patients with pancreatic carcinoma and help patient selection for optimal treatment.
Highlights
Pancreatic cancer is one of the most lethal malignancies, accounting for the 7th leading cause of cancer-related mortality worldwide [1]
In the context of non-metastatic disease, patients with resectable or borderline resectable pancreatic carcinoma might benefit from neoadjuvant chemo- or chemoradiotherapy followed by surgeryPatients with locally advanced ormetastatic tumors presenting significant response to chemotherapy should undergo surgery if R0 resection seems to be achievable
It is estimated that about 458,000 people will be diagnosed with pancreatic cancer worldwide in 2018, and more than 432,000 will die of this disease. 5-year survival in patients with pancreatic cancer is as low as 9% in the USA [2]
Summary
Pancreatic cancer is one of the most lethal malignancies, accounting for the 7th leading cause of cancer-related mortality worldwide [1]. 5-year survival in patients with pancreatic cancer is as low as 9% in the USA [2]. Progress has been made in multimodality treatment with surgery and adjuvant therapy, the mortality rate of pancreatic cancer is still increasing throughout the years. The disappointing prognosis of this disease is largely attributable to its late diagnosis, as most patients with pancreatic cancer remain asymptomatic until the disease develops to an advanced stage [3]. Tumor biology of pancreatic cancer may contribute to its early metastasis. A preclinical study using a mouse model of pancreatic cancer indicates that early metastasis might possibly be detected even when there is no primary tumor found in the pancreas and is associated with epithelial-to-mesenchymal transition and focal inflammation [5]. Sci. 2019, 20, x FOR PEER REVIEW cancerTsrienactmluednetsosfupragnecrrye,actihcecmanoctehresrianpcylu, draesdisautrigoenryth, cehreampyo,thaenrdappya,lrliaadtiiavteiocnatrhee, rwaphyic, hanadrepsaelllieactitveed on the basciasreo,fwdhisicehasaerestsaelgeect(eFdigounrteh1e)b. aHsiesroef wdieseraesveiestwagteh(eFicguurrreen1)t. cHlienriecwalesrteravtieewgiethseincutrhreenttrecalitnmiceanl t of pancresatrtaictedguiecstainl athdeetnroeactamrceinntoomf apa(nPcDreAatCic),dtuhcetaml aodsetncoocmarmcinoonmtayp(PeDoAf Cp)a,nthcreematoicstccaonmcemros,nintydpeiffoefrent scenarpioasnc(rreeasteicctcaabnlcee,rbs,oirndedriflfienreenret sseccetnaabriloes, l(orecsaelclytabaldev, abnorcdeedr,liannedremseectabsltea,tilcocPaDllyAaCd)v,aanncdedp, oatnedntial novel ampeptarsotactihcePsDuAnCd)e,radnedveplootpenmtieanl tnboavseel dapopnrothaceheexspuannddeirndgemveololepcmuelanrt bbiaosleodgyonknthoewelxepdagned. ing molecular biology knowledge
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