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Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives. | LitMetric

Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives.

Ther Adv Med Oncol

Gastroenterology and Digestive Oncology Department, Cochin Hospital, APHP. Centre, Paris, France.

Published: July 2021

AI Article Synopsis

  • - Major advancements in treating metastatic pancreatic ductal adenocarcinoma (PDAC) include first-line therapies like FOLFIRINOX and gemcitabine plus nab-paclitaxel, but patient prognosis remains poor despite these options.
  • - For patients who respond well initially, second-line chemotherapy and maintenance therapy, such as 5-fluorouracil post-FOLFIRINOX, may help control tumors while preserving quality of life.
  • - New FDA approvals for specific treatments based on genetic profiles, like larotrectinib and pembrolizumab, highlight ongoing research in targeted therapy and immunotherapy aimed at enhancing patient outcomes.

Article Abstract

Major breakthroughs have been achieved in the management of metastatic pancreatic ductal adenocarcinoma (PDAC) with FOLFIRINOX (5-fluorouracil + irinotecan + oxaliplatin) and gemcitabine plus nab-paclitaxel approved as a first-line therapy, although the prognosis is still poor. At progression, patients who maintain a good performance status (PS) can benefit from second-line chemotherapy. To address the concern of achieving tumor control while maintaining a good quality of life, maintenance therapy is a concept that has now emerged. After a FOLFIRINOX induction treatment, maintenance with 5-fluorouracil (5-FU) seems to offer a promising approach. Although not confirmed in large, prospective trials, gemcitabine alone as a maintenance therapy following induction treatment with gemcitabine plus nab-paclitaxel could be an option, while a small subset of patients with a germline mutation of breast cancer gene ( can benefit from the polyadenosine diphosphate-ribose polymerase (PARP) inhibitor olaparib. The rate of PDAC with molecular alterations that could lead to a specific therapy is up to 25%. The Food and Drug Administration (FDA) recently approved larotrectinib for patients with any tumors harboring a neurotrophic tyrosine receptor kinase ( gene fusion, and pembrolizumab for patients with a mismatch repair deficiency in a second-line setting, including PDAC. Research focused on targeted therapy and immunotherapy is active and could improve patients' outcomes in the near future.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264726PMC
http://dx.doi.org/10.1177/17588359211018539DOI Listing

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