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Update on the management of pancreatic cancer: Surgery is not enough.

Ansari, Daniel LU ; Gustafsson, Adam and Andersson, Roland LU (2015) In World Journal of Gastroenterology 21(11). p.3157-3165
Abstract
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
World Journal of Gastroenterology
volume
21
issue
11
pages
3157 - 3165
publisher
WJG Press
external identifiers
  • pmid:25805920
  • wos:000351165100001
  • scopus:84925618087
ISSN
1007-9327
DOI
10.3748/wjg.v21.i11.3157
language
English
LU publication?
yes
id
abb28423-9930-4096-8097-a2bd011c031e (old id 5257661)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25805920?dopt=Abstract
date added to LUP
2015-04-04 17:54:14
date last changed
2017-11-12 03:02:17
@misc{abb28423-9930-4096-8097-a2bd011c031e,
  abstract     = {Pancreatic ductal adenocarcinoma (PDAC) represents the fourth cause of death in cancer and has a 5-year survival of &lt; 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.},
  author       = {Ansari, Daniel and Gustafsson, Adam and Andersson, Roland},
  issn         = {1007-9327},
  language     = {eng},
  number       = {11},
  pages        = {3157--3165},
  publisher    = {WJG Press},
  series       = {World Journal of Gastroenterology},
  title        = {Update on the management of pancreatic cancer: Surgery is not enough.},
  url          = {http://dx.doi.org/10.3748/wjg.v21.i11.3157},
  volume       = {21},
  year         = {2015},
}