Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3157
Peer-review started: November 15, 2014
First decision: December 11, 2014
Revised: December 19, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: March 21, 2015
Pancreatic ductal adenocarcinoma (PDAC) represents the fourth cause of death in cancer and has a 5-year survival of < 5%. Only about 15% of the patients present with a resectable PDAC with potential to undergo “curative” surgery. After surgery, local and systemic recurrence, is though very common. The median survival of resected patients with adjuvant chemotherapy after surgery is only 20-23 mo. This underscores the significant need to improve PDAC management strategies. Increased survival rate is dependent on new breakthroughs in our understanding of not at least tumor biology. The aim of this review is to update and comment on recent knowledge concerning PDAC biology and new diagnostics and treatment modalities. One fundamental approach to improve survival rates is by earlier and improved diagnosis of the disease. In recent years, novel blood-based biomarkers have emerged based on genetic, epigenetic and protein changes in PDAC with very promising results. For biomarkers to enter clinical practice they need to have been developed using adequate control groups and provide high sensitivity and specificity and by this identify patients at risk already in a pre-symptomatic stage. Another way to improve outcomes, is by employing neoadjuvant treatments thereby increasing the number of resectable cases. Novel systemic treatment regimes like FOLFIRINOX and nab-paclitaxel have demonstrated improvements in prolonging survival in advanced cases, but long-term survival is still scarce. The future improved understanding of PDAC biology will inevitably render new treatment options directed against both the cancer cells and the surrounding microenvironment.
Core tip: This review updates the current progress in the management of pancreatic cancer with focus on novel modes of diagnosis and treatment. New blood-based biomarkers for early detection based on genetic, epigenetic and protein changes in pancreatic cancer are discussed and new treatment strategies such as stromal depletion are highlighted. Pancreatic cancer is a systemic disease already at diagnosis and demands multimodal managements strategies in order to improve outcomes.