Multiple randomized trials have suggested that the addition of comprehensive metastasis-directed therapy to best systemic therapy improves disease control and survival among patients with oligometastatic disease, even for histologies with a high propensity for rapid spread. Here, we review the growing literature supporting the oligometastatic paradigm in pancreatic ductal adenocarcinoma. We summarize key details from nascent institutional series and reflect on the recently reported phase II randomized EXTEND trial. We discuss various strategies for enhancing the clinical and technical implementation of metastasis-directed therapy in this patient population. Lastly, we highlight multiple ongoing landmark trials seeking to optimize and validate the role of metastasis-directed therapy in oligometastatic pancreatic cancer. Ultimately, these and other continued clinical and translational research efforts will be critical to improve care and outcomes for patients with oligometastatic pancreatic ductal adenocarcinoma.
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Evolving Paradigms in the Treatment of Oligometastatic Pancreatic Ductal Adenocarcinoma.
J Gastrointest Cancer
January 2025
Department of Gastrointestinal Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Multiple randomized trials have suggested that the addition of comprehensive metastasis-directed therapy to best systemic therapy improves disease control and survival among patients with oligometastatic disease, even for histologies with a high propensity for rapid spread. Here, we review the growing literature supporting the oligometastatic paradigm in pancreatic ductal adenocarcinoma. We summarize key details from nascent institutional series and reflect on the recently reported phase II randomized EXTEND trial.
View Article and Find Full Text PDFEnhancing the Immunotherapeutic Effect by IP-001 and Irreversible Electroporation in Mouse Oligometastatic Models of Pancreatic Adenocarcinoma.
Ann Surg Oncol
December 2024
Division of Surgical Oncology, Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA.
Background: This study aimed to evaluate the immunotherapeutic effect of irreversible electroporation (IRE) and IP-001 in pancreatic adenocarcinoma with metastasis.
Methods: Orthotopic models of pancreatic adenocarcinoma with hepatic oligometastasis were established by implantation of tumor tissues (derived from Pan02 or KPC cells) size 2 mm into the pancreas and left liver lobe in C57BL/6J mice. One week after implantation, the tumor-burden mice were subjected to saline control, IRE, IP-001, and IRE+IP-001.
Introduction: Pancreatic cancer is one of the most aggressive tumors diagnosed in local-ly advanced or metastatic stage in more than half of the cases. The standard of care is a systemic chemotherapy but the prognosis of metastatic patients remains extremely poor with a median overall survival less than one year. However, there is increasing evidence of surgery treatment benefit in a carefully selected oligometastatic cases.
View Article and Find Full Text PDFCurrently, no international consensus includes surgery as part of the standard of metastatic pancreatic ductal adenocarcinoma care. There is weak evidence to support the general introduction of surgical resection in the metastatic pancreatic ductal adenocarcinoma treatment. However, in the rare cases of oligometastatic spread there is increasing evidence that surgical intervention can lead to favourable outcomes.
View Article and Find Full Text PDFSurvival Outcomes and Genetic Characteristics of Resected Pancreatic Acinar Cell Carcinoma.
Ann Surg Oncol
November 2024
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Article Synopsis
- The study focuses on pancreatic acinar cell carcinoma (pACC), a rare type of pancreatic cancer, highlighting its clinical characteristics, genetic mutations, and patient survival outcomes.
- A total of 61 patients who underwent surgery between 1999 and 2022 were analyzed, showing a median overall survival of 73 months and a recurrence-free survival of 22 months; those with oligometastatic disease had even better outcomes.
- Significant genetic findings included mutations in core genes related to DNA repair pathways in 26% of patients, indicating potential avenues for targeted treatment.
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