Featured
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Review Article |
Neoadjuvant therapy for pancreatic cancer
Advances in surgical technique and chemotherapy regimens have improved the survival outcomes of patients with pancreatic cancer, although these remain dismal relative to most other solid tumours. Attempts to further improve outcomes have led to increasing research interest in neoadjuvant therapy, which is beginning to improve the outcomes of certain subgroups of patients. In this Review, the authors provide an overview of the various neoadjuvant therapy approaches for patients with pancreatic cancer, including discussions of several promising future research directions
- Christoph Springfeld
- , Cristina R. Ferrone
- & John Neoptolemos
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News & Views |
The role of neoadjuvant therapy for resectable pancreatic cancer remains uncertain
Patients with pancreatic ductal adenocarcinoma (PDAC) usually have a dismal prognosis, and even after curative resection most patients will have disease relapse and ultimately die. Nonetheless, adjuvant chemotherapy has considerably improved the outcomes of patients who are able to undergo surgery. The PREOPANC trial provides some evidence supporting the use of neoadjuvant therapy for patients with borderline resectable PDACs but not, as claimed, for those with resectable tumours.
- Christoph Springfeld
- & John P. Neoptolemos
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Review Article |
The tumour microenvironment in pancreatic cancer — clinical challenges and opportunities
Important research efforts are being made to develop therapeutic strategies targeting the tumour microenvironment in pancreatic adenocarcinoma. The authors of this Review describe the apparent contradiction between preclinical studies and clinical outcomes observed to date, presenting more sophisticated strategies under active investigation.
- Won Jin Ho
- , Elizabeth M. Jaffee
- & Lei Zheng
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Review Article |
From state-of-the-art treatments to novel therapies for advanced-stage pancreatic cancer
Virtually all patients with resectable pancreatic ductal adenocarcinoma (PDAC) will have disease progression, which is generally associated with dismal outcomes. However, novel targeted therapies and immunotherapies, selected based on the genomic and/or clinical features of patients’ tumours are beginning to improve the outcomes in subsets of patients. In this Review, the authors describe progress in novel therapies for patients with PDAC.
- Christopher Nevala-Plagemann
- , Manuel Hidalgo
- & Ignacio Garrido-Laguna
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News & Views |
Microbes as biomarkers and targets in pancreatic cancer
The presence and prognostic relevance of the intratumoural microbiota in pancreatic cancer, and the roles of intratumoural bacteria in oncogenesis and therapeutic response are beginning to be elucidated. The feasibility of characterizing intratumoural microbial communities from paraffin-embedded tissues has now been validated, providing greater opportunities for retrospective research. Prospective studies are also needed to test the efficacy of rational approaches combining microbial modulation with chemotherapy and/or immunotherapy.
- Joshua C. Leinwand
- & George Miller
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News & Views |
PARP inhibition — opportunities in pancreatic cancer
An urgent clinical need exists to improve the survival of patients with pancreatic cancer through biomarker-driven therapeutic strategies. Such approaches include the targeting of metastatic pancreatic cancer that harbours germline BRCA mutations with poly(ADP-ribose) polymerase inhibitors as maintenance therapy following platinum-based chemotherapy.
- Shubham Pant
- , Anirban Maitra
- & Timothy A. Yap
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Review Article |
Optimizing the outcomes of pancreatic cancer surgery
Successful surgical resection offers patients with pancreatic cancer the best chance of survival. However, many patients do not have surgically resectable disease. In this Review, the authors describe recent improvements in pancreatic cancer surgery, which have increased survival and also enabled more patients to undergo surgery.
- Oliver Strobel
- , John Neoptolemos
- & Markus W. Büchler
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News & Views |
Clinical practice guidelines — what is the evidence?
In three practice guidelines from ASCO, experts provide evidence-based recommendations that address overarching clinical questions for the management of patients with pancreatic cancer. These guidelines offer improved strategies for interdisciplinary patient management and highlight the need for further research in several areas.
- Oliver Strobel
- & Markus W. Büchler
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Review Article |
Nanomedicine strategies to overcome the pathophysiological barriers of pancreatic cancer
Intrinsic pathophysiological barriers limit the delivery of drugs to pancreatic cancers, contributing to the limited effectiveness of treatment. Nanomedicine approaches have the potential to overcome many of these drug-delivery challenges, and two nanoparticle therapies are now approved for the treatment of this disease. The authors discuss the key pathobiological barriers that must be overcome, the approaches to nanomedicine that have been pursued to date, and those that are the focus of ongoing research.
- Pavan P. Adiseshaiah
- , Rachael M. Crist
- & Scott E. McNeil
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News & Views |
New drug for pancreatic cancer highlights the dual effect of regulatory approvals
The recent FDA approval of MM-398 as a second-line treatment of metastatic pancreatic cancer, based on a 1.9-month overall survival benefit observed in the NAPOLI-1 trial, adds a new therapeutic option for this notoriously difficult-to-treat disease; however, by discouraging clinical trial enrolment, this approval might have negative consequences for the development of novel agents, which remain an essential unmet need.
- Susan E. Bates
- & Tito Fojo
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News & Views |
Targeting KRAS and the vitamin D receptor via microtubules
Pancreatic cancer remains a difficult-to-treat malignancy, yet nab-paclitaxel plus gemcitabine prolongs survival. Closer examination of the mechanism of action of nab-paclitaxel hints at a role for targeting KRAS. We discuss how nab-paclitaxel may be active in pancreatic cancer and how this informs the way forward to better treat patients with pancreatic cancer.
- Agnes Basseville
- , Susan Bates
- & Tito Fojo
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Review Article |
Pancreatic cancer: from state-of-the-art treatments to promising novel therapies
The survival rates of patients with pancreatic cancer are low and have not improved significantly over the past three or four decades. Thus, effective treatments for this disease are an urgent unmet need. Novel treatment paradigms will probably be required, and many new therapeutic approaches are being tested in this setting. This Review outlines the state-of-the-art therapies for patients with pancreatic cancer, as well as the novel treatment strategies that are the focus of drug-development efforts.
- Ignacio Garrido-Laguna
- & Manuel Hidalgo
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In Brief |
Optimal timing for post-surgery chemotherapy
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Review Article |
Advanced-stage pancreatic cancer: therapy options
Although surgery is a requirement for a potential cure from pancreatic cancer, it is usually diagnosed at a late stage, when surgical intervention is not straightforward. This Review article outlines the controversies surrounding the treatment options for patients with advanced-stage pancreatic cancer, from surgery through to chemotherapy, radiotherapy, targeted agents and palliative care.
- Jens Werner
- , Stephanie E. Combs
- & Markus W. Büchler
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News & Views |
Is it time for Dr Whipple's orphans to have a Facebook page?
The 8-year European Study Group for Pancreatic Cancer has determined that adjuvant chemotherapy for periampullary neoplasms prolongs survival compared with surgery alone. Is now the time to implement social networks or other web-based applications to assist investigators and clinicians to find the optimal treatment faster?
- Robert A. Wolff
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News & Views |
The importance of local control in pancreatic cancer
The ECOG E4201 study adds another piece of information to a growing body of evidence pointing strongly to the importance of local control and the role of radiotherapy in unresectable pancreatic cancer. Based on this evidence, we believe radiotherapy should be used routinely in this setting.
boxed-text - Edgar Ben-Josef
- & Theodore S. Lawrence
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News & Views |
Metastatic pancreatic cancer—is FOLFIRINOX the new standard?
In the phase III ACCORD 11 trial, FOLFIRINOX was associated with the longest survival ever reported for patients with metastatic pancreatic cancer (11.1 months). However, toxicities associated with the four-drug regimen will limit its use to patients with a good performance status.
- M. Wasif Saif
- & John Chabot
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News & Views |
Good news for advanced-stage pancreatic neuroendocrine tumors
A phase III, randomized, placebo-controlled trial in 171 patients with advanced-stage pancreatic neuroendocrine tumors demonstrated a significant improvement in progression-free survival with sunitinib treatment. We discuss the results of this trial in the context of other studies that have assessed treatment of pancreatic neuroendocrine tumors.
- Allen M. Spiegel
- & Steven K. Libutti
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