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Article: Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management.

Hartwig, Werner / Büchler, Markus W

2013 Volume 1, Issue 1, Page(s) 41–52

Abstract: Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive ... lesions combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic ... role in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor ...

Abstract	Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive tumor growth which hampers most of the current treatment modalities. This review aims to summarize the available evidence about the diagnostic and therapeutic aspects of resectable and non-resectable pancreatic cancer therapy. Summary: Embedded in the concept of multimodal therapy, surgery plays the central role in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor resection as the most relevant positive prognostic factors, the detection of premalignant or early invasive lesions combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic adenocarcinomas are locally advanced or metastatic when diagnosed and need to be treated by the combination of surgery and (radio)chemotherapy or by palliative chemotherapy.
Language	English
Publishing date	2013-09-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2735769-7
ISSN	2296-3766 ; 2296-3774
ISSN (online)	2296-3766
ISSN	2296-3774
DOI	10.1159/000354992
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Hartwig, Werner / Büchler, Markus W.

Gastrointestinal Tumors

2013 Volume 1, Issue 1, Page(s) 41–52

Abstract: Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive tumor ... combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic ... in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor resection ...

Institution	Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
Abstract	Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive tumor growth which hampers most of the current treatment modalities. This review aims to summarize the available evidence about the diagnostic and therapeutic aspects of resectable and non-resectable pancreatic cancer therapy. Summary: Embedded in the concept of multimodal therapy, surgery plays the central role in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor resection as the most relevant positive prognostic factors, the detection of premalignant or early invasive lesions combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic adenocarcinomas are locally advanced or metastatic when diagnosed and need to be treated by the combination of surgery and (radio)chemotherapy or by palliative chemotherapy. Key Message An interdisciplinary, multimodal approach to therapy is critical for improving the outcomes of patients with pancreatic cancer. Practical Implications Cross-sectional imaging techniques (such as contrast-enhanced multidetector computed tomography) are useful for assessing tumor resectability. For localized, non-metastatic, resectable tumors, the necessity of preoperative biopsies remains controversial. Important prognostic parameters are tumor size, invasion of surrounding tissue, lymph node metastasis and distant metastasis. Various classification systems based on the TNM system have been used for tumor staging and prognosis. The presence of distant metastases is regarded as non-resectable disease, requiring chemotherapy as first treatment. The definition of borderline resectable tumors is still under debate, although a recent definition has been provided by an expert consensus statement. Standard lymphadenectomy is the recommended procedure in pancreatoduodenectomy, based upon the guidelines of the International Study Group of Pancreatic Surgery (ISGPS). Adjuvant chemotherapy is applied in generally all cases of pancreatic ductal adenocarcinoma following macroscopic complete tumor resection. The benefits of adjuvant chemoradiotherapy or immunochemoradiotherapy, or neoadjuvant therapy, however, remain a matter of controversy. For palliative treatment gemcitabine monotherapy is widely used; the FOLFIRINOX protocol provides an alternative for a minority of patients.
Keywords	Diagnostics ; Multimodal therapy ; Palliative therapy ; Pancreatic ductal adenocarcinoma ; Surgery
Language	English
Publishing date	2013-09-12
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Mini-Review
ZDB-ID	2735769-7
ISSN	2296-3766 ; 2296-3774
ISSN (online)	2296-3766
ISSN	2296-3774
DOI	10.1159/000354992
Database	Karger publisher's database

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Article ; Online: Pancreatic cancer.

Kleeff, Jorg / Korc, Murray / Apte, Minoti / La Vecchia, Carlo / Johnson, Colin D / Biankin, Andrew V / Neale, Rachel E / Tempero, Margaret / Tuveson, David A / Hruban, Ralph H / Neoptolemos, John P

Nature reviews. Disease primers

2016 Volume 2, Page(s) 16022

Abstract: ... of which are currently druggable. Indeed, therapeutic options are limited and progress in drug development is ... for pancreatic cancer research and patient management. ... we summarize the current understanding of the salient pathophysiological, molecular, translational and clinical ...

Abstract	Pancreatic cancer is a major cause of cancer-associated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades. Currently, prevention or early diagnosis at a curable stage is exceedingly difficult; patients rarely exhibit symptoms and tumours do not display sensitive and specific markers to aid detection. Pancreatic cancers also have few prevalent genetic mutations; the most commonly mutated genes are KRAS, CDKN2A (encoding p16), TP53 and SMAD4 - none of which are currently druggable. Indeed, therapeutic options are limited and progress in drug development is impeded because most pancreatic cancers are complex at the genomic, epigenetic and metabolic levels, with multiple activated pathways and crosstalk evident. Furthermore, the multilayered interplay between neoplastic and stromal cells in the tumour microenvironment challenges medical treatment. Fewer than 20% of patients have surgically resectable disease; however, neoadjuvant therapies might shift tumours towards resectability. Although newer drug combinations and multimodal regimens in this setting, as well as the adjuvant setting, appreciably extend survival, ∼80% of patients will relapse after surgery and ultimately die of their disease. Thus, consideration of quality of life and overall survival is important. In this Primer, we summarize the current understanding of the salient pathophysiological, molecular, translational and clinical aspects of this disease. In addition, we present an outline of potential future directions for pancreatic cancer research and patient management.
MeSH term(s)	Animals ; Animals, Genetically Modified/immunology ; Biomarkers, Tumor/analysis ; Biomarkers, Tumor/blood ; Diabetes Mellitus/etiology ; Early Detection of Cancer/standards ; Humans ; Jaundice/etiology ; Magnetic Resonance Imaging/methods ; Mice ; Models, Animal ; Neoplasm Proteins/analysis ; Neoplasm Proteins/blood ; Pancreatic Neoplasms/epidemiology ; Pancreatic Neoplasms/immunology ; Pancreatic Neoplasms/physiopathology ; Prognosis ; Proto-Oncogene Proteins p21(ras)/analysis ; Proto-Oncogene Proteins p21(ras)/blood ; Risk Factors ; Tomography, X-Ray Computed/methods ; Weight Loss/immunology
Chemical Substances	Biomarkers, Tumor ; KRAS protein, human ; Neoplasm Proteins ; cancer basic protein, human ; Proto-Oncogene Proteins p21(ras) (EC 3.6.5.2)
Language	English
Publishing date	2016-04-21
Publishing country	England
Document type	Journal Article ; Review
ISSN	2056-676X
ISSN (online)	2056-676X
DOI	10.1038/nrdp.2016.22
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Article: New Treatment Options in Metastatic Pancreatic Cancer.

Fudalej, Marta / Kwaśniewska, Daria / Nurzyński, Paweł / Badowska-Kozakiewicz, Anna / Mękal, Dominika / Czerw, Aleksandra / Sygit, Katarzyna / Deptała, Andrzej

Cancers

2023 Volume 15, Issue 8

Abstract: ... the strengths of each therapy are needed. This review summarises the current literature and provides an overview ... of new or emerging therapeutic strategies for the more effective management of metastatic PC. ... metastases, and remarkable resistance to most conventional treatment options. The pathogenesis of PC seems ...

Abstract	Pancreatic cancer (PC) is the seventh leading cause of cancer death across the world. Poor prognosis of PC is associated with several factors, such as diagnosis at an advanced stage, early distant metastases, and remarkable resistance to most conventional treatment options. The pathogenesis of PC seems to be significantly more complicated than originally assumed, and findings in other solid tumours cannot be extrapolated to this malignancy. To develop effective treatment schemes prolonging patient survival, a multidirectional approach encompassing different aspects of the cancer is needed. Particular directions have been established; however, further studies bringing them all together and connecting the strengths of each therapy are needed. This review summarises the current literature and provides an overview of new or emerging therapeutic strategies for the more effective management of metastatic PC.
Language	English
Publishing date	2023-04-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15082327
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Article ; Online: Systemic Therapy for Metastatic Pancreatic Cancer.

Ettrich, Thomas J / Seufferlein, Thomas

Current treatment options in oncology

2021 Volume 22, Issue 11, Page(s) 106

Abstract: ... and still has a poor prognosis. Over the last decades, chemotherapy of metastatic pancreatic cancer ... treatment are combination chemotherapy regimens such as FOLFIRINOX and gemcitabine plus nab-paclitaxel ... with mPDAC and a BRCA1/-2 germ line mutation having received at least 16 weeks of platinum-based chemotherapy ...

Abstract	Opinion statement: Pancreatic cancer is mainly diagnosed at an advanced, often metastatic stage and still has a poor prognosis. Over the last decades, chemotherapy of metastatic pancreatic cancer (mPDAC) has proven to be superior to a mere supportive treatment with respect to both survival and quality of life. Recently, even sequential treatment of mPDAC could be established. Options for first-line treatment are combination chemotherapy regimens such as FOLFIRINOX and gemcitabine plus nab-paclitaxel when the performance status of the patient is good. For patients with poorer performance status, gemcitabine single-agent treatment is a valid option. Recently, the PARP inhibitor olaparib has been demonstrated to improve progression-free survival when used as a maintenance treatment in the subgroup of patients with mPDAC and a BRCA1/-2 germ line mutation having received at least 16 weeks of platinum-based chemotherapy. This group of patients also benefits from platinum-based chemotherapy combinations. Therefore, the BRCA1/-2 stats should be examined early in patients with mPDAC even when the occurrence of these mutations is only about 5% in the general Caucasian population. After the failure of first-line treatment, patients should be offered a second-line treatment if their ECOG permits further treatment. Here, the combination of 5-FU/FA plus nanoliposomal irinotecan has shown to be superior to 5-FU/FA alone with respect to overall survival. Immune checkpoint inhibitors like PD1/PD-L1 mAbs are particularly efficacious in tumors with high microsatellite instability (MSI-h). Limited data in mPDACs shows that only a part of the already small subgroup of MSI-H mPDACs (frequency about 1%) appears to benefit substantially from a checkpoint inhibitor treatment. The identification of further subgroups, e.g., tumors with DNA damage repair deficiency, gene fusions, as well as novel approaches such as tumor-organoid-informed treatment decisions, may further improve therapeutic efficacy.
MeSH term(s)	Age Factors ; Biomarkers, Tumor ; Clinical Decision-Making ; Clinical Trials as Topic ; Combined Modality Therapy/adverse effects ; Combined Modality Therapy/methods ; Disease Management ; Disease Susceptibility ; Humans ; Molecular Diagnostic Techniques ; Neoplasm Grading ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/etiology ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/therapy ; Prognosis ; Retreatment ; Treatment Outcome
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2021-10-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057351-0
ISSN	1534-6277 ; 1527-2729
ISSN (online)	1534-6277
ISSN	1527-2729
DOI	10.1007/s11864-021-00895-4
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Article: Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective.

Dahiya, Dushyant Singh / Chandan, Saurabh / Ali, Hassam / Pinnam, Bhanu Siva Mohan / Gangwani, Manesh Kumar / Al Bunni, Hashem / Canakis, Andrew / Gopakumar, Harishankar / Vohra, Ishaan / Bapaye, Jay / Al-Haddad, Mohammad / Sharma, Neil R

Cancers

2023 Volume 15, Issue 12

Abstract: ... laparoscopic approaches. In this article, we detail the most current and important therapeutic applications ... EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era ... stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover ...

Abstract	Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a delay in diagnosis and treatment, resulting in poor clinical outcomes and low survival rates. Endoscopic Ultrasound (EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era, with exponential advancements in technology and device innovation, EUS is also being increasingly used in a variety of therapeutic interventions. In the context of pancreatic cancer where therapies are limited due to the advanced stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover, due to their minimally invasive nature and ability to provide real-time images for tumor localization and therapy, they are associated with fewer complication rates compared to conventional open and laparoscopic approaches. In this article, we detail the most current and important therapeutic applications of EUS for pancreatic cancer, namely EUS-guided Fine Needle Injections, EUS-guided Radiotherapy, and EUS-guided Ablations. Furthermore, we also discuss the feasibility and safety profile of each intervention in patients with pancreatic cancer to provide gastrointestinal medical oncologists, radiation and surgical oncologists, and therapeutic endoscopists with valuable information to facilitate patient discussions and aid in the complex decision-making process.
Language	English
Publishing date	2023-06-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15123235
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Article ; Online: Imaging and Management of Pancreatic Cancer.

Kobi, Mariya / Veillette, Gregory / Narurkar, Roshni / Sadowsky, David / Paroder, Viktoriya / Shilagani, Chaitanya / Gilet, Anthony / Flusberg, Milana

Seminars in ultrasound, CT, and MR

2019 Volume 41, Issue 2, Page(s) 139–151

Abstract: ... advances in imaging and therapeutic options. Surgical resection is currently the only curative treatment ... of pancreatic cancer with a focus on diagnosis and staging, operative and nonoperative treatments, and post-therapeutic ... in the multidisciplinary approach to this disease. This article will provide a broad overview of the imaging and management ...

Abstract	Pancreatic cancer is an aggressive disease with rising incidence and high mortality despite advances in imaging and therapeutic options. Surgical resection is currently the only curative treatment, with expanding roles for adjuvant and neoadjuvant chemoradiation. Accurate detection, staging, and post-treatment monitoring of pancreatic cancer are critical to improving survival and imaging plays a central role in the multidisciplinary approach to this disease. This article will provide a broad overview of the imaging and management of pancreatic cancer with a focus on diagnosis and staging, operative and nonoperative treatments, and post-therapeutic appearances after surgery and chemoradiation therapy.
MeSH term(s)	Diagnosis, Differential ; Diagnostic Imaging/methods ; Humans ; Pancreas/diagnostic imaging ; Pancreas/surgery ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/therapy
Language	English
Publishing date	2019-12-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1353113-x
ISSN	1558-5034 ; 0887-2171
ISSN (online)	1558-5034
ISSN	0887-2171
DOI	10.1053/j.sult.2019.12.003
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Article: An update on treatment options for pancreatic adenocarcinoma.

Lambert, Aurélien / Schwarz, Lilian / Borbath, Ivan / Henry, Aline / Van Laethem, Jean-Luc / Malka, David / Ducreux, Michel / Conroy, Thierry

Therapeutic advances in medical oncology

2019 Volume 11, Page(s) 1758835919875568

Abstract: ... This review summarizes the current literature and provides an overview of how new therapies or new therapeutic ... late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths ... on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and ...

Abstract	Pancreatic cancer is one of the most lethal solid organ tumors. Due to the rising incidence, late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths in high income countries in the next decade. The multidisciplinary treatment of this disease depends on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and combines surgery, chemotherapy, chemoradiotherapy, and supportive care. The landscape of multidisciplinary pancreatic cancer treatment is changing rapidly, especially in locally advanced disease, and the number of treatment options in metastatic disease, including personalized medicine, innovative targets, immunotherapy, therapeutic vaccines, adoptive T-cell transfer, or stemness inhibitors, will probably expand in the near future. This review summarizes the current literature and provides an overview of how new therapies or new therapeutic strategies (neoadjuvant therapies, conversion surgery) will guide multidisciplinary disease management, future clinical trials, and, hopefully, will increase overall survival.
Language	English
Publishing date	2019-09-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2503443-1
ISSN	1758-8359 ; 1758-8340
ISSN (online)	1758-8359
ISSN	1758-8340
DOI	10.1177/1758835919875568
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Article ; Online: Defining and Treating Borderline Resectable Pancreatic Cancer.

Perri, Giampaolo / Prakash, Laura / Katz, Matthew H G

Current treatment options in oncology

2020 Volume 21, Issue 9, Page(s) 71

Abstract: ... Patients with BR PDAC should be categorized at diagnosis on the basis of anatomical, biological, and ... therapies might be most effective, and to reduce the anatomic extent of tumors to facilitate surgical ... conditional criteria and should be offered induction systemic chemotherapy with close monitoring for toxicity ...

Abstract	Opinion statement: Patients with borderline resectable pancreatic ductal adenocarcinoma (BR PDAC) should receive preoperative chemotherapy with or without radiation therapy, with the intent to eradicate occult metastatic cancer cells, to select patients with a "locally dominant cancer phenotype" for whom local therapies might be most effective, and to reduce the anatomic extent of tumors to facilitate surgical resection. The administration of preoperative therapy may also be a useful strategy to deliver the maximum load of chemotherapy to patients with BR PDAC, since as many as half of patients will never qualify for adjuvant treatments following pancreatectomy due to postoperative morbidity or disease progression. Patients with BR PDAC should be categorized at diagnosis on the basis of anatomical, biological, and conditional criteria and should be offered induction systemic chemotherapy with close monitoring for toxicity, followed by administration of (chemo)radiation in selected cases. Patients should be restaged after systemic therapy and, if used, (chemo)radiation. Patients who continue to show disease response or disease stability without signs of progression should be considered for pancreatectomy; better measures of response to therapy are needed.
MeSH term(s)	Biomarkers, Tumor ; Clinical Decision-Making ; Combined Modality Therapy ; Disease Management ; Disease Susceptibility ; Humans ; Neoplasm Staging/methods ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/etiology ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/therapy ; Preoperative Care ; Prognosis ; Treatment Outcome
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2020-07-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2057351-0
ISSN	1534-6277 ; 1527-2729
ISSN (online)	1534-6277
ISSN	1527-2729
DOI	10.1007/s11864-020-00769-1
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Article ; Online: An update on the management of pancreatic neuroendocrine tumors.

Gao, Limin / Natov, Nikola S / Daly, Kevin P / Masud, Faisal / Chaudhry, Sadia / Sterling, Mark J / Saif, Muhammad W

Anti-cancer drugs

2018 Volume 29, Issue 7, Page(s) 597–612

Abstract: ... reviewed the current treatment and also discussed the emerging agents and emphasized the need to identify ... in their clinical presentation, behavior, and prognosis based on both histological features and cancer stage ... at the time of diagnosis. Although small-sized tumors can be surgically resected, locally advanced and ...

Abstract	Pancreatic neuroendocrine tumors (PNETs) are a rare and heterogeneous group of neoplasia and differ in their clinical presentation, behavior, and prognosis based on both histological features and cancer stage at the time of diagnosis. Although small-sized tumors can be surgically resected, locally advanced and metastatic tumors confer a poor prognosis. In addition, only limited treatment options are available to the latter group of patients with PNETs, such as hormonal analogs, cytotoxic agents, and targeted therapy. In selected patients, liver-directed therapies are also used. As expected, clinicians taking care of these patients are challenged to develop an effective and comprehensive treatment strategy for their patients amid a wide variety of treatment modalities. Targeted therapy for PNETs is limited to sunitinib and everolimus. Presently, a number of clinical studies are ongoing to assess the efficacy of newer targeted agents alone and in combination with previous agents for the treatment of advanced PNETs. The authors reviewed the current treatment and also discussed the emerging agents and emphasized the need to identify biomarkers.
MeSH term(s)	Antineoplastic Agents/administration & dosage ; Antineoplastic Agents/therapeutic use ; Biomarkers, Tumor/genetics ; Biomarkers, Tumor/metabolism ; Everolimus/administration & dosage ; Everolimus/therapeutic use ; Humans ; Molecular Targeted Therapy ; Neoplasm Staging ; Neovascularization, Pathologic/prevention & control ; Neuroendocrine Tumors/blood supply ; Neuroendocrine Tumors/diagnostic imaging ; Neuroendocrine Tumors/drug therapy ; Pancreatic Neoplasms/blood supply ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/drug therapy ; Prognosis ; Sunitinib/administration & dosage ; Sunitinib/therapeutic use
Chemical Substances	Antineoplastic Agents ; Biomarkers, Tumor ; Everolimus (9HW64Q8G6G) ; Sunitinib (V99T50803M)
Language	English
Publishing date	2018-05-21
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1065301-6
ISSN	1473-5741 ; 0959-4973
ISSN (online)	1473-5741
ISSN	0959-4973
DOI	10.1097/CAD.0000000000000633
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