New Treatments in Pancreatic Ductal Adenocarcinoma

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Gastrointestinal Oncology".

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 6581

Special Issue Editor


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Guest Editor
Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Interests: gastrointestinal surgical oncology; hepatobiliary surgery

Special Issue Information

Dear Colleagues,

Pancreatic ductal adenocarcinoma (PDAC) continues to increase in incidence; however, survival remains dismal. A large percentage of patients are diagnosed at a late stage when surgery is not technically feasible, leaving few treatment options. A lack of reliable methods of early detection and its therapeutic resistance makes it one of the most highly lethal malignancies. New treatment strategies are being investigated which may ultimately improve the prognosis of pancreatic cancer and potentially convert later-stage patients to having a resectable disease. New treatments for pancreatic cancer are aided by improvements in radiologic imaging, analysis and manipulation of the tumor microenvironment, genomic diagnostics, understanding of pancreatic tumor biology and advances in surgical techniques.

In this Special Issue of Current Oncology, we invite authors to submit work focusing on new treatments in PDAC. Original articles, as well as review articles focusing on advances in radiologic, medical, surgical, and radiation therapy for pancreatic cancer are welcome.

I look forward to hearing from you.

Dr. Kelly J. Lafaro
Guest Editor

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Keywords

  • pancreatic cancer
  • novel treatments
  • novel therapies
  • targeted therapies
  • immune therapy
  • vaccine therapy
  • pancreatic ductal adenocarcinoma
  • pancreatic surgery
  • chemotherapy for pancreatic cancer
  • surgery

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Published Papers (5 papers)

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Research

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14 pages, 602 KiB  
Article
Oncological Outcomes of Open Versus Minimally Invasive Surgery for Ductal Adenocarcinomas of Pancreatic Head: A Propensity Score Matching Analysis
by Alessandro Giani, Michele Mazzola, Michele Paterno, Andrea Zironda, Pietro Calcagno, Emma Zuppi, Paolo De Martini and Giovanni Ferrari
Curr. Oncol. 2024, 31(10), 6096-6109; https://doi.org/10.3390/curroncol31100455 - 11 Oct 2024
Viewed by 601
Abstract
Background: Minimally invasive pancreatic resections (MIPRs) have been shown to be safe and feasible, but there is still a lack of high-level evidence on oncological outcomes for cephalic pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to compare the oncological outcomes [...] Read more.
Background: Minimally invasive pancreatic resections (MIPRs) have been shown to be safe and feasible, but there is still a lack of high-level evidence on oncological outcomes for cephalic pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to compare the oncological outcomes of patients undergoing MIPR and open pancreatic resection (OPR) for pancreatic head cancer in a single high-volume center. Methods: Data from a prospectively collected database of patients who underwent radical-intent surgery for resectable and borderline resectable PDAC of the head at our institution between January 2013 and May 2023 were retrieved and analyzed, comparing the surgical and oncological outcomes of MIPR and OPR, using a propensity score matching analysis. Results: In the study period, 220 patients were selected. After matching, a total of 81 MIPRs and 81 OPRs were compared. No difference was found regarding R0 rate (OPR 83.9% vs. MIPR 74.1%, p = 0.122). Median overall survival (24 and 31 months for the OPR and MIPR groups, respectively; log rank p = 0.665) and disease-free survival (12 and 21 months for the OPR and MIPR groups, respectively; log rank p = 0.118) did not differ between the groups. The MIPR group was associated with a greater number of harvested lymph nodes (22 vs. 16, p = 0.0008), longer operative time (565 vs. 420 min, p < 0.0001), and shorter length of stay (12 vs. 18 days; p = 0.0001). No differences between the groups were found regarding all other postoperative and pathological outcomes. Conclusions: Regarding oncological outcomes, MIPR appeared to be comparable to OPR for treating patients with PDAC of the head. Despite an increased operative time, MIPR was associated with a greater number of LNs harvested and a shorter length of stay. Full article
(This article belongs to the Special Issue New Treatments in Pancreatic Ductal Adenocarcinoma)
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13 pages, 1165 KiB  
Article
Adult Pancreatoblastoma: Clinical Insights and Outcomes Compared to Pancreatic Ductal Adenocarcinoma (PDAC)
by Han Yin, Fernanda Romero-Hernandez, Amir Ashraf Ganjouei, Jaeyun Jane Wang, Audrey Brown, Kenzo Hirose, Ajay V. Maker, Eric Nakakura, Carlos Corvera, Kimberly S. Kirkwood, Alexander Wilhelm, June S. Peng, Adnan Alseidi and Mohamed A. Adam
Curr. Oncol. 2024, 31(9), 5008-5020; https://doi.org/10.3390/curroncol31090370 - 28 Aug 2024
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Abstract
Pancreatoblastoma is perceived to be aggressive in adults; however, data are limited due to the rarity of the disease. We benchmarked clinico-pathologic characteristics, outcomes, and survival of adult patients with pancreatoblastoma to a comparable PDAC cohort using the National Cancer Database (NCDB). This [...] Read more.
Pancreatoblastoma is perceived to be aggressive in adults; however, data are limited due to the rarity of the disease. We benchmarked clinico-pathologic characteristics, outcomes, and survival of adult patients with pancreatoblastoma to a comparable PDAC cohort using the National Cancer Database (NCDB). This study included 301,204 patients: 35 with pancreatoblastoma and 301,169 PDAC patients. Pancreatoblastoma patients were younger than PDAC patients (56 vs. 69 years, p < 0.001). More pancreatoblastoma patients were managed at academic institutions (63.0% vs. 40.7%, p = 0.047). The most frequent primary site was the head and the neck of the pancreas. There were no differences in tumor size (4.2 cm vs. 3.7 cm, p = 0.828), lymph node positivity (14.3% vs. 26.4%, p = 0.103), or metastasis at time of diagnosis (31.4% vs. 46.1%, p = 0.081). The majority of pancreatoblastoma patients underwent resection compared to a minority of PDAC patients (69.7% vs. 15.5%, p < 0.001). Time from diagnosis to surgery was longer for pancreatoblastoma patients (33 vs. 14 days, p = 0.030). Pancreaticoduodenectomy was the most common type of resection in the pancreatoblastoma and PDAC groups (47.8% vs. 67.7%, p = 0.124). Among resected patients, pancreatoblastoma patients were less likely to receive radiation (4.8% vs. 37.0%, p = 0.002), but the use of chemotherapy was similar to PDAC patients (60.9% vs. 70.7%). After matching, median overall survival was longer for pancreatoblastoma than PDAC (59.8 months vs. 15.2 months, p = 0.014). Full article
(This article belongs to the Special Issue New Treatments in Pancreatic Ductal Adenocarcinoma)
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Review

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18 pages, 330 KiB  
Review
Systemic Therapy for Metastatic Pancreatic Cancer—Current Landscape and Future Directions
by Daniel Netto, Melissa Frizziero, Victoria Foy, Mairéad G. McNamara, Alison Backen and Richard A. Hubner
Curr. Oncol. 2024, 31(9), 5206-5223; https://doi.org/10.3390/curroncol31090385 - 4 Sep 2024
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Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a significant cause of cancer-associated mortality, with a rising global incidence. A paucity of strong predictive risk factors mean screening programmes are difficult to implement. Historically, a lack of identifiable and actionable driver mutations, coupled with a relatively [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is a significant cause of cancer-associated mortality, with a rising global incidence. A paucity of strong predictive risk factors mean screening programmes are difficult to implement. Historically, a lack of identifiable and actionable driver mutations, coupled with a relatively immunosuppressed tumour microenvironment, has led to a reliance on cytotoxic chemotherapy. The NAPOLI-3 trial has reported data supporting consideration of NALIRIFOX as a new first-line standard of care. Kirsten Rat Sarcoma Virus (KRAS) G12D mutations are present in >90% of all PDAC’s; exciting breakthroughs in small molecule inhibitors targeting KRAS G12D may open new modalities of treatment, and therapies targeting multiple KRAS mutations are also in early clinical trials. Although immunotherapy strategies to date have been disappointing, combination with chemotherapy and/or small molecule inhibitors hold promise and warrant further exploration. Full article
(This article belongs to the Special Issue New Treatments in Pancreatic Ductal Adenocarcinoma)
30 pages, 2368 KiB  
Review
Developing Vaccines in Pancreatic Adenocarcinoma: Trials and Tribulations
by Thuy Phan, Darrell Fan and Laleh G. Melstrom
Curr. Oncol. 2024, 31(9), 4855-4884; https://doi.org/10.3390/curroncol31090361 - 23 Aug 2024
Viewed by 1596
Abstract
Pancreatic adenocarcinoma represents one of the most challenging malignancies to treat, with dismal survival rates despite advances in therapeutic modalities. Immunotherapy, particularly vaccines, has emerged as a promising strategy to harness the body’s immune system in combating this aggressive cancer. This abstract reviews [...] Read more.
Pancreatic adenocarcinoma represents one of the most challenging malignancies to treat, with dismal survival rates despite advances in therapeutic modalities. Immunotherapy, particularly vaccines, has emerged as a promising strategy to harness the body’s immune system in combating this aggressive cancer. This abstract reviews the trials and tribulations encountered in the development of vaccines targeting pancreatic adenocarcinoma. Key challenges include the immunosuppressive tumor microenvironment, the heterogeneity of tumor antigens, and a limited understanding of immune evasion mechanisms employed by pancreatic cancer cells. Various vaccine platforms, including peptide-based, dendritic cell-based, and viral vector-based vaccines, have been explored in preclinical and clinical settings. However, translating promising results from preclinical models to clinical efficacy has proven elusive. In recent years, mRNA vaccines have emerged as a promising immunotherapeutic strategy in the fight against various cancers, including pancreatic adenocarcinoma. We will discuss the potential applications, opportunities, and challenges associated with mRNA vaccines in pancreatic cancer treatment. Full article
(This article belongs to the Special Issue New Treatments in Pancreatic Ductal Adenocarcinoma)
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14 pages, 1685 KiB  
Review
Multimodal Approaches to Patient Selection for Pancreas Cancer Surgery
by Hala Muaddi, LaDonna Kearse and Susanne Warner
Curr. Oncol. 2024, 31(4), 2260-2273; https://doi.org/10.3390/curroncol31040167 - 15 Apr 2024
Cited by 1 | Viewed by 1396
Abstract
With an overall 5-year survival rate of 12%, pancreas ductal adenocarcinoma (PDAC) is an aggressive cancer that claims more than 50,000 patient lives each year in the United States alone. Even those few patients who undergo curative-intent resection with favorable pathology reports are [...] Read more.
With an overall 5-year survival rate of 12%, pancreas ductal adenocarcinoma (PDAC) is an aggressive cancer that claims more than 50,000 patient lives each year in the United States alone. Even those few patients who undergo curative-intent resection with favorable pathology reports are likely to experience recurrence within the first two years after surgery and ultimately die from their cancer. We hypothesize that risk factors for these early recurrences can be identified with thorough preoperative staging, thus enabling proper patient selection for surgical resection and avoiding unnecessary harm. Herein, we review evidence supporting multidisciplinary and multimodality staging, comprehensive neoadjuvant treatment strategies, and optimal patient selection for curative-intent surgical resections. We further review data generated from our standardized approach at the Mayo Clinic and extrapolate to inform potential future investigations. Full article
(This article belongs to the Special Issue New Treatments in Pancreatic Ductal Adenocarcinoma)
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