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Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives

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, patie...

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Autores principales: Lellouche, Lisa, Palmieri, Lola-Jade, Dermine, Solène, Brezault, Catherine, Chaussade, Stanislas, Coriat, Romain
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264726/
https://www.ncbi.nlm.nih.gov/pubmed/34285720
http://dx.doi.org/10.1177/17588359211018539
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author Lellouche, Lisa
Palmieri, Lola-Jade
Dermine, Solène
Brezault, Catherine
Chaussade, Stanislas
Coriat, Romain
author_facet Lellouche, Lisa
Palmieri, Lola-Jade
Dermine, Solène
Brezault, Catherine
Chaussade, Stanislas
Coriat, Romain
author_sort Lellouche, Lisa
collection PubMed
description 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 (BRCA) 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 (NTRK) 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.
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spelling pubmed-82647262021-07-19 Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives Lellouche, Lisa Palmieri, Lola-Jade Dermine, Solène Brezault, Catherine Chaussade, Stanislas Coriat, Romain Ther Adv Med Oncol Advances in Treatment of Lung Cancer Patients with Targetable Mutations 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 (BRCA) 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 (NTRK) 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. SAGE Publications 2021-07-06 /pmc/articles/PMC8264726/ /pubmed/34285720 http://dx.doi.org/10.1177/17588359211018539 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Advances in Treatment of Lung Cancer Patients with Targetable Mutations
Lellouche, Lisa
Palmieri, Lola-Jade
Dermine, Solène
Brezault, Catherine
Chaussade, Stanislas
Coriat, Romain
Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title_full Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title_fullStr Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title_full_unstemmed Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title_short Systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
title_sort systemic therapy in metastatic pancreatic adenocarcinoma: current practice and perspectives
topic Advances in Treatment of Lung Cancer Patients with Targetable Mutations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264726/
https://www.ncbi.nlm.nih.gov/pubmed/34285720
http://dx.doi.org/10.1177/17588359211018539
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