Pancreatic cancer-improved care achievable

Abstract

Pancreatic adenocarcinoma is one of the most aggressive cancers, and the decline in mortality observed in most other cancer diseases, has so far not taken place in pancreatic cancer. Complete tumor resection is a requirement for potential cure, and the reorganization of care in the direction of high patient-volume centers, offering multimodal treatment, has improved survival and Quality of Life. Also the rates and severity grade of complications are improving in high-volume pancreatic centers. One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer. Suboptimal investigation, follow up and oncological treatment outside specialized centers are additional key problems. New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease, and different adjuvant treatment options result in well documented survival benefit. Neoadjuvant treatment is highly relevant, but needs further evaluation. Also adjuvant immunotherapy, in the form of vaccination with synthetic K-Ras-peptides, has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors. Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention.

Keywords: Pancreatic cancer, Pathogenesis, Prevention, Diagnosis, Treatment, Evidence-based medicine, Immunotherapy, Adjuvant chemotherapy, Neoadjuvant chemotherapy

Core tip: Curative treatment outcome for patients with pancreatic cancer is achievable if early surgical treatment is combined with adjuvant chemotherapy. Nevertheless, most patients end up in a palliative situation, earlier or later. Also palliative therapeutic interventions are improving, but a multidisciplinary team with advanced expertise is a prerequisite for optimal care.