Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan
Systemic chemotherapy plays an important role in the treatment of pancreatic cancer, to improve the survival of patients with pancreatic cancer. Unresectable pancreatic cancer can be classified into three categories: metastatic, locally advanced, and hereditary pancreatic cancers. Furthermore, the s...
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doaj-e33734e20d6d44c7971c6c740a1731802020-11-25T01:02:44ZengMDPI AGJournal of Clinical Medicine2077-03832019-08-0188117010.3390/jcm8081170jcm8081170Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in JapanJunji Furuse0Department of Medical Oncology, Kyorin University Faculty of Medicine, 6-20-2, Shinkawa, Mitaka-Shi, Tokyo 181-8611, JapanSystemic chemotherapy plays an important role in the treatment of pancreatic cancer, to improve the survival of patients with pancreatic cancer. Unresectable pancreatic cancer can be classified into three categories: metastatic, locally advanced, and hereditary pancreatic cancers. Furthermore, the second-line chemotherapy is required to prolong the survival. The combined regimens of oxaliplatin, irinotecan, fluorouracil and leucovorin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel (GEM plus nab-PTX) have been recognized as the standard of care for advanced pancreatic cancer. However, the consensus of selection of the first-line chemotherapy still remains. Randomized controlled trials (RCTs) between FOLFIRINOX and GEM plus nab-PTX are ongoing for locally advanced and metastatic disease in Japan, respectively. Hereditary pancreatic cancer, especially associated with <i>BRCA</i> mutations, is responsive to platinum-containing regimens and/or poly (ADP-ribose) polymerase (PARP) inhibitors. It is becoming more important to examine the presence/absence of <i>BRCA</i> mutations to select the appropriate treatment strategy for individual patients. Although some S-1-based regimens have been investigated in the second-line treatment after GEM-based chemotherapy in Japan, no regime demonstrated survival benefit. Nanoliposomal irinotecan (nal-IRI) plus FF has been established as the standard of care in the second-line treatment in a global phase III trial (NAPOLI-1). A randomized phase II trial comparing FF plus nal-IRI with FF alone was also conducted in Japan to examine the efficacy and safety of the FF plus nal-IRI in Japanese patients.https://www.mdpi.com/2077-0383/8/8/1170metastatic pancreatic cancerlocally advanced pancreatic cancerhereditary pancreatic cancersecond-line chemotherapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Junji Furuse |
spellingShingle |
Junji Furuse Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan Journal of Clinical Medicine metastatic pancreatic cancer locally advanced pancreatic cancer hereditary pancreatic cancer second-line chemotherapy |
author_facet |
Junji Furuse |
author_sort |
Junji Furuse |
title |
Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan |
title_short |
Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan |
title_full |
Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan |
title_fullStr |
Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan |
title_full_unstemmed |
Paradigm Shifting of Systemic Chemotherapy for Unresectable Pancreatic Cancer in Japan |
title_sort |
paradigm shifting of systemic chemotherapy for unresectable pancreatic cancer in japan |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2019-08-01 |
description |
Systemic chemotherapy plays an important role in the treatment of pancreatic cancer, to improve the survival of patients with pancreatic cancer. Unresectable pancreatic cancer can be classified into three categories: metastatic, locally advanced, and hereditary pancreatic cancers. Furthermore, the second-line chemotherapy is required to prolong the survival. The combined regimens of oxaliplatin, irinotecan, fluorouracil and leucovorin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel (GEM plus nab-PTX) have been recognized as the standard of care for advanced pancreatic cancer. However, the consensus of selection of the first-line chemotherapy still remains. Randomized controlled trials (RCTs) between FOLFIRINOX and GEM plus nab-PTX are ongoing for locally advanced and metastatic disease in Japan, respectively. Hereditary pancreatic cancer, especially associated with <i>BRCA</i> mutations, is responsive to platinum-containing regimens and/or poly (ADP-ribose) polymerase (PARP) inhibitors. It is becoming more important to examine the presence/absence of <i>BRCA</i> mutations to select the appropriate treatment strategy for individual patients. Although some S-1-based regimens have been investigated in the second-line treatment after GEM-based chemotherapy in Japan, no regime demonstrated survival benefit. Nanoliposomal irinotecan (nal-IRI) plus FF has been established as the standard of care in the second-line treatment in a global phase III trial (NAPOLI-1). A randomized phase II trial comparing FF plus nal-IRI with FF alone was also conducted in Japan to examine the efficacy and safety of the FF plus nal-IRI in Japanese patients. |
topic |
metastatic pancreatic cancer locally advanced pancreatic cancer hereditary pancreatic cancer second-line chemotherapy |
url |
https://www.mdpi.com/2077-0383/8/8/1170 |
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