Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward
Globally, the death rate of pancreatic ductal adenocarcinoma (PDAC) has doubled over 30 years and is likely to further increase, making PDAC a leading cause of cancer-related death in the coming years. PDAC is typically diagnosed at an advanced stage, and modified FOLFIRINOX or nab-paclitaxel and ge...
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doaj-77e1e8fcd4ec4d70b9daaf26c190019a2020-11-25T03:20:52ZengMDPI AGCancers2072-66942020-07-01121955195510.3390/cancers12071955Advanced Pancreatic Ductal Adenocarcinoma: Moving ForwardCaspar Franck0Christian Müller1Rosa Rosania2Roland S. Croner3Maciej Pech4Marino Venerito5Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, GermanyDepartment of General-, Visceral-, Vascular- and Transplant Surgery, Otto-von-Guericke University Hospital Magdeburg, 39120 Magdeburg, GermanyDepartment of Radiology and Nuclear Medicine, Otto-von-Guericke University Hospital, 39120 Magdeburg, GermanyDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, GermanyGlobally, the death rate of pancreatic ductal adenocarcinoma (PDAC) has doubled over 30 years and is likely to further increase, making PDAC a leading cause of cancer-related death in the coming years. PDAC is typically diagnosed at an advanced stage, and modified FOLFIRINOX or nab-paclitaxel and gemcitabine are the mainstay of systemic therapy. For elderly patients with good performance status, low-dose treatment can preserve quality of life without compromising cancer control or survival. Maintenance therapy should be considered in PDAC patients achieving disease control with systemic therapy. In particular, olaparib has demonstrated a progression-free survival benefit of 3.6 months in a subgroup of PDAC patients with germline BRCA1/2 mutations (ca. 10% of all PDAC). Pancreatic enzyme replacement therapy is often omitted in the treatment of patients with PDAC, with possibly deleterious consequences. Small intestinal bacterial overgrowth is highly prevalent in patients with PDAC and should be considered in the diagnostic algorithm of PDAC patients with bloating and diarrhea. Rivaroxaban has been associated with a reduced risk of thrombosis without an increase in major bleeding events, and its use should be considered in every patient with advanced PDAC undergoing systemic therapy.https://www.mdpi.com/2072-6694/12/7/1955pancreatic ductal adenocarcinomapalliative therapymaintenance therapysupportive therapybiomarkermolecular subtypes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Caspar Franck Christian Müller Rosa Rosania Roland S. Croner Maciej Pech Marino Venerito |
spellingShingle |
Caspar Franck Christian Müller Rosa Rosania Roland S. Croner Maciej Pech Marino Venerito Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward Cancers pancreatic ductal adenocarcinoma palliative therapy maintenance therapy supportive therapy biomarker molecular subtypes |
author_facet |
Caspar Franck Christian Müller Rosa Rosania Roland S. Croner Maciej Pech Marino Venerito |
author_sort |
Caspar Franck |
title |
Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward |
title_short |
Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward |
title_full |
Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward |
title_fullStr |
Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward |
title_full_unstemmed |
Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward |
title_sort |
advanced pancreatic ductal adenocarcinoma: moving forward |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2020-07-01 |
description |
Globally, the death rate of pancreatic ductal adenocarcinoma (PDAC) has doubled over 30 years and is likely to further increase, making PDAC a leading cause of cancer-related death in the coming years. PDAC is typically diagnosed at an advanced stage, and modified FOLFIRINOX or nab-paclitaxel and gemcitabine are the mainstay of systemic therapy. For elderly patients with good performance status, low-dose treatment can preserve quality of life without compromising cancer control or survival. Maintenance therapy should be considered in PDAC patients achieving disease control with systemic therapy. In particular, olaparib has demonstrated a progression-free survival benefit of 3.6 months in a subgroup of PDAC patients with germline BRCA1/2 mutations (ca. 10% of all PDAC). Pancreatic enzyme replacement therapy is often omitted in the treatment of patients with PDAC, with possibly deleterious consequences. Small intestinal bacterial overgrowth is highly prevalent in patients with PDAC and should be considered in the diagnostic algorithm of PDAC patients with bloating and diarrhea. Rivaroxaban has been associated with a reduced risk of thrombosis without an increase in major bleeding events, and its use should be considered in every patient with advanced PDAC undergoing systemic therapy. |
topic |
pancreatic ductal adenocarcinoma palliative therapy maintenance therapy supportive therapy biomarker molecular subtypes |
url |
https://www.mdpi.com/2072-6694/12/7/1955 |
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