Current Approaches to the Management of Locally Advanced Pancreatic Cancer

• Published in: Current surgery reports (Philadelphia, PA) Vol. 11; no. 10; pp. 260 - 269
• Main Authors: Malinosky, Hannah R., Stewart, John H., Moaven, Omeed
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2023
• Subjects: Medicine; Medicine & Public Health; Section Editor; Surgery; Surgical Oncology (John Stewart; Biomarkers; Neoadjuvant therapy; Surgical resection; FOLFIRINOX; Gemcitabine; Locally advanced pancreatic cancer
• ISSN: 2167-4817; 2167-4817
• DOI: 10.1007/s40137-023-00370-z

Purpose of Review
Pancreatic cancer is one of the deadliest malignancies in the United States and the world. The Current standard of treatment fails to provide a durable response, and ongoing investigations are focused on developing novel local and systemic therapies. About a third of patients have locally advanced pancreatic cancer at the time of diagnosis and are considered unresectable. This review aims to summarize current standards and recent advancements in the management of locally advanced pancreatic cancer (LAPC) and highlight areas for further advancement.
Recent Findings
FOLFIRINOX and gemcitabine-based chemotherapy regimens have become the standard of care in LAPC. They have increased the chances of converting LAPC to resectable tumors, but still, the majority of tumors remain unresectable despite treatment. The survival benefits of adding radiation are not well established. Ongoing research for local therapies is promising.
Summary
LAPC is defined as unresectable at the time of diagnosis due to a significant involvement of adjacent vasculature. Despite advancements, the prognosis remains poor for patients with LAPC. R0 resection is the only potentially curative treatment option, and resection should only be attempted when complete resection is attainable. The goal of therapy in patients with good performance status should be evaluating the tumor biology for appropriate patient selection, downsizing the tumor, and minimizing the extent of vascular involvement to facilitate a complete surgical resection. Efforts are focused on developing novel treatment modalities with durable responses.