Recent Developments in Pancreatic Cancer Treatment

In recent years, particularly in malignant melanoma of the skin and in kidney, lung, and breast cancers, there have been remarkable advances with targeted therapies and immunotherapies . However, pancreatic cancer has not benefited from these encouraging developments as much as hoped. The main reason appears to be its much more complex tumor microenvironment . Nevertheless, although targeted therapies and immunotherapies have not worked in pancreatic cancer, cytotoxic chemotherapy in different combinations has produced advances that improve survival both in postoperative adjuvant (protective) treatment and in the treatment of metastatic (advanced-stage) disease.

Let us take a brief look at these developments...

Comparing Adjuvant Treatments in Pancreatic Cancer

Approximately 10% of pancreatic cancers are at an early stage when diagnosed; in other words, only 1 in every 10 patients with pancreatic cancer can undergo surgery immediately at diagnosis. However, after pancreatic cancer surgery , treatments are needed to reduce the risk of recurrence . For years, the benefit of chemotherapy given after pancreatic cancer surgery (adjuvant treatment, commonly called protective treatment) was controversial because a contribution to overall survival had not been demonstrated, and the overall survival benefit was limited to 2 months.

Published over the past two years, clinical studies have brought substantial improvements in disease-free survival and overall survival. With new treatment strategies, survival that used to be 22 months can now exceed 50 months. Of course, in some patients the disease never recurs, and a complete cure may be possible.

Manage preferences to view external content

Manage preferences to view external content

Comparing Neoadjuvant Treatments in Pancreatic Cancer

Treatment given before surgery to shrink the tumor is called neoadjuvant treatment. Today, neoadjuvant treatment is routinely used as a lifesaving approach in suitable patients with many cancers, particularly rectal and breast cancer. Patients advised to undergo cancer surgery should therefore obtain a medical oncology opinion on whether drug treatment is needed before surgery. Pancreatic cancer is also often already too large to be completely removed surgically when it is first encountered. In such cases, shrinking the tumor with neoadjuvant treatment may improve surgical success and thereby contribute to survival. Meta-analyses (comprehensive studies) evaluating neoadjuvant treatment have shown improved surgical success (20% better outcomes) and higher survival rates (a survival benefit of 11 months). Neoadjuvant treatment should therefore be considered in suitable patients.

Manage preferences to view external content

Manage preferences to view external content

Comparing Treatments in Metastatic Pancreatic Cancer

Pancreatic cancer is most often diagnosed beyond the stage at which surgery is possible, or when it is metastatic. Major advances in systemic treatment are therefore needed. So far, treatments that began with fluorouracil have progressed to a certain point through combination treatment strategies. However, there is a great need for different approaches. No targeted therapy has shown a clear benefit. Only in the subgroup with a positive BRCA mutation (approximately 7.4% of all patients) has the PARP inhibitor olaparib, used as maintenance (continuing) treatment after first-line chemotherapy, been shown to reduce the risk of disease progression by 47%. Olaparib received FDA approval for pancreatic cancer treatment on December 27, 2019 (see here). This marked the first approval in pancreatic cancer of a treatment targeting a biomarker .

Manage preferences to view external content

Manage preferences to view external content

As shown, efforts to control pancreatic cancer use existing treatments in different combinations. New targets and new sources of hope are therefore needed in pancreatic cancer.