Raising the Bar in Advanced Pancreatic Cancer

Abstract

Pancreatic cancer remains one of our greatest clinical challenges. In the last 5 years we have witnessed the introduction of new agents into our armamentarium, which has fortunately translated into incremental improvements in overall survival. We have level 1 evidence for the use of FOLFIRINOX and nab-paclitaxel in the first-line setting; however, the generalizability of randomized studies in the second-line setting has been less compelling. The use of oxaliplatin and 5-fluorouracil (5FU) post-gemcitabine progression was shown to improve survival in the CONKO-003 trial but failed to do so in the PANCREOX trial. Nano-liposomal irinotecan in combination with 5FU in pre-treated patients yielded an improved survival in the NAPOLI-1 trial, presenting an option in this setting. However, these trials were largely conducted in an era of first-line gemcitabine monotherapy, which is no longer a standard practice. Better evidence with contemporary first-line regimens is needed in order to define the optimal post-progression strategy in advanced pancreatic cancer.