Metastatic pancreatic ductal adenocarcinoma: diagnosis and treatment with a view to the future

Adrian M J Pokorny; Venessa T Chin; Adnan M Nagrial; Desmond Yip; Lorraine A Chantrill

doi:10.1111/imj.13810

Metastatic pancreatic ductal adenocarcinoma: diagnosis and treatment with a view to the future

Intern Med J. 2018 Jun;48(6):637-644. doi: 10.1111/imj.13810.

Authors

Adrian M J Pokorny^{1

2

3}, Venessa T Chin^{1

4}, Adnan M Nagrial^{5

6}, Desmond Yip^{7

8}, Lorraine A Chantrill^{1

4}

Affiliations

¹ Department of Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
² Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
³ Central Clinical School, University of Sydney, New South Wales, Australia.
⁴ Garvan Institute of Medical Research, New South Wales, Australia.
⁵ Department of Medical Oncology, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
⁶ University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia.
⁷ Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
⁸ Australian National University Medical School, Canberra, Australian Capital Territory, Australia.

PMID: 29898269
DOI: 10.1111/imj.13810

Abstract

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a lethal disease with a poor 5-year survival. Systemic treatments can be used to control symptoms and prolong life. Cytotoxic chemotherapies are commonly administered, with combination treatments, such as fluorouracil, folinic acid, irinotecan and oxaliplatin (FOLFIRINOX) or nab-paclitaxel and gemcitabine showing the largest clinical benefits. Newer genomic classifications of PDAC may provide a rationale for targeted therapies or immunotherapies, although at present these remain largely experimental. This review discusses the evidence behind the currently used regimens, while introducing the potential future of pancreatic cancer care.

Keywords: adenocarcinoma; cancer genomics; clinical trials; cytotoxic chemotherapy; metastatic; pancreatic cancer.

Publication types

Review

MeSH terms

Adenocarcinoma / drug therapy*
Adenocarcinoma / secondary
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Carcinoma, Pancreatic Ductal / drug therapy*
Carcinoma, Pancreatic Ductal / secondary
Drug Combinations
Fluorouracil / therapeutic use
Humans
Immunotherapy / trends
Irinotecan
Leucovorin / therapeutic use
Organometallic Compounds / therapeutic use
Oxaliplatin
Pancreatic Neoplasms / drug therapy*
Pancreatic Neoplasms / pathology
Practice Guidelines as Topic
Randomized Controlled Trials as Topic

Substances

Drug Combinations
Organometallic Compounds
folfirinox
Oxaliplatin
Irinotecan
Leucovorin
Fluorouracil