Recent advances in the treatment of pancreatic adenocarcinoma

Although pancreatic cancer is rare, it is the fourth-leading cause of cancer-related mortality. Pancreatic adenocarcinoma is the most common type of pancreatic cancer, accounting for approximately 95% of cases. At diagnosis, it is estimated that less than 10% of patients have localized disease, 29% have regional disease, and 52% have distant metastases and might be eligible for palliative treatment only. Optimal management of pancreatic cancer requires early referral to a medical oncologist. Therapeutic goals should address both symptom improvement and survival. In the metastatic setting, advances in systemic therapy are improving outcome. For years, the standard therapy was single-agent gemcitabine, and this approach is still used for patients who have a poor performance status, who are elderly, or who have comorbidities. More recent strategies include oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) and gemcitabine plus albumin-bound (nab)-paclitaxel. In 2015, the US Food and Drug Administration approved the use of nanoliposomal irinotecan in combination with fluorouracil and leucovorin for the treatment of patients with metastatic adenocarcinoma of the pancreas after disease progression following gemcitabine-based therapy. Multiple novel strategies are being evaluated for patients with pancreatic cancer. A multidisciplinary team that includes an interventional gastroenterologist is appropriate for all patients with pancreatic cancer, regardless of disease stage. Proactive management of potential complications is essential for maintaining adherence to treatment and maximizing clinical outcomes.