Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10502-10511
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10502
Updated therapeutic outcome for patients with periampullary and pancreatic cancer related to recent translational research
Trond A Buanes
Trond A Buanes, Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, N-0424 Oslo, Norway
Trond A Buanes, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0424 Oslo, Norway
Author contributions: Buanes TA solely contributed to this manuscript.
Conflict-of-interest statement: The author has no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Trond A Buanes, MD, PhD, Professor of Surgery, Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, Nydalen, N-0424 Oslo, Norway.
Telephone: +47-23070958 Fax: +47-23072526
Received: August 15, 2016
Peer-review started: August 16, 2016
First decision: October 11, 2016
Revised: October 14, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 28, 2016

Chemotherapy with improved effect in patients with metastatic pancreatic cancer has recently been established, launching a new era for patients with this very aggressive disease. FOLFIRINOX and gemcitabine plus nab-paclitaxel are different regimens, both capable of stabilizing the disease, thus increasing the number of patients who can reach second line and even third line of treatment. Concurrently, new windows of opportunity open for nutritional support and other therapeutic interventions, improving quality of life. Also pancreatic surgery has changed significantly during the latest years. Extended operations, including vascular/multivisceral resections are frequently performed in specialized centers, pushing borders of resectability. Potentially curative treatment including neoadjuvant and adjuvant chemotherapy is offered new patient groups. Translational research is the basis for the essential understanding of the ongoing development. Even thou biomarkers for clinical management of patients with periampullary tumors have almost been lacking, biomarker driven trials are now in progress. New insight is constantly made available for clinicians; one recent example is selection of patients for gemcitabine treatment based on the expression level of the human equilibrium nucleoside transporter 1. An example of new diagnostic tools is identification of early pancreatic cancer patients by a three-biomarker panel in urine: The proteins lymphatic vessel endothelial hyaluronan receptor 1, regenerating gene 1 alpha and translation elongation factor 1 alpha. Requirement of treatment guideline revisions is intensifying, as combined chemotherapy regimens result in unexpected advantages. The European Study Group for Pancreatic Cancer 4 trial outcome is an illustration: Addition of capecitabine in the adjuvant setting improved overall survival more than expected from the effect in advanced disease. Rapid implementation of new treatment options is mandatory when progress finally extends to patients with this serious disease.

Keywords: Chemotherapy, Clinical outcome, Evidence-based medicine, Molecular expression profiling, Pancreatic cancer, Periampullary tumor, Prognostic markers, Survival

Core tip: More effective chemotherapy and reorganized care for patients with periampullary carcinoma has opened windows of opportunity for improved surgical performance. Combined with neoadjuvant and adjuvant chemotherapy new patient groups can therefore be offered potentially curative treatment. A biomarkers can predict gemcitabine sensitivity, thus improving patient selection. A three-biomarker panel in urine can identify patients with early pancreatic adenocarcinoma. Clinical implementation of new diagnostic and therapeutic options is mandatory.