Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 27-43
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.27
Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians
Rosella Spadi, Federica Brusa, Agostino Ponzetti, Isabella Chiappino, Nadia Birocco, Libero Ciuffreda, Maria Antonietta Satolli
Rosella Spadi, Federica Brusa, Agostino Ponzetti, Isabella Chiappino, Nadia Birocco, Libero Ciuffreda, Maria Antonietta Satolli, Department of Oncology, Azienda Ospedaliera Città della Salute e della Scienza, 10126 Torino, Italy
Author contributions: Spadi R designed and wrote the paper; all the other authors equally contributed to write and revise this paper.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
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: Rosella Spadi, MD, Consultant Medical Oncologist, Department of Oncology, Azienda Ospedaliera Città della Salute e della Scienza, corso Bramante 88, 10126 Torino, Italy.
Telephone: +39-11-6335189 Fax: +39-11-6334382
Received: May 29, 2015
Peer-review started: June 2, 2015
First decision: July 31, 2015
Revised: September 22, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: February 10, 2016

Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.

Keywords: Pancreatic cancer, Chemotherapy, Radio-frequency, Stereotactic radiotherapy, Irreversible electroporation

Core tip: This review focuses on the current clinical practice in the treatment of pancreatic cancer (PC), and outlines research topics. PC is still a highly lethal disease, for a usual presentation stage not manageable with curative surgery. Up to now, new targeted therapies have not shown any positive impact on its dismal prognosis. Only slight improvements ensued from the availability of more active polychemotherapy regimens. From the point of view of a multimodal approach, in addition to surgery, new locoregional techniques are nowadays available, suitable for combination with systemic treatments, to increase disease control and survival.