切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 640 -643. doi: 10.3877/cma.j.issn.2095-3232.2024.05.009

专家论坛

胰腺癌新辅助化疗现状和治疗策略
王军华1,(), 王锐炫1   
  1. 1. 528000 广东省佛山市第一人民医院胆胰外科
  • 收稿日期:2024-06-30 出版日期:2024-10-10
  • 通信作者: 王军华
  • 基金资助:
    佛山市"十四五"医学重点专科和培育专科(FSGSP14500)

Current status and treatment strategy of neoadjuvant chemotherapy for pancreatic cancer

Junhua Wang1,(), Ruixuan Wang1   

  1. 1. Department of Biliary and Pancreatic Surgery, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2024-06-30 Published:2024-10-10
  • Corresponding author: Junhua Wang
引用本文:

王军华, 王锐炫. 胰腺癌新辅助化疗现状和治疗策略[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 640-643.

Junhua Wang, Ruixuan Wang. Current status and treatment strategy of neoadjuvant chemotherapy for pancreatic cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 640-643.

胰腺导管腺癌(PDAC)患者最好的治疗方法是手术切除原发病灶加全身化疗,联合治疗方式能提供更好的总体生存期(OS)。大多数患者术后因微转移而复发,而新辅助化疗可改善OS。约20%的不可切除PDAC患者可能会在4~6个月的诱导治疗联合化疗后进行切除,从而改善其OS。本文阐述目前PDAC不同临床阶段的治疗策略,以期为提升我国胰腺癌整体治疗水平提供参考。

Surgical resection of the primary lesion combined with systemic chemotherapy is the optimal treatment for pancreatic ductal adenocarcinoma (PDAC). Combined treatment can yield longer overall survival (OS). Most patients recur due to postoperative micrometastasis, and neoadjuvant chemotherapy can improve OS. Approximately 20% of patients with unresectable PDAC might undergo resection after 4-6 month induction therapy combined with chemotherapy, thereby improving the OS. We described current treatment strategies for PDAC in different clinical stages, aiming to provide a reference for enhancing the overall treatment level for pancreatic cancer in China.

[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1):7-30.
[2]
Nevala-Plagemann C, Hidalgo M, Garrido-Laguna I. From state-of-the-art treatments to novel therapies for advanced-stage pancreatic cancer[J]. Nat Rev Clin Oncol, 2020, 17(2):108-123.
[3]
Strobel O, Neoptolemos J, Jäger D, et al. Optimizing the outcomes of pancreatic cancer surgery[J]. Nat Rev Clin Oncol, 2019, 16(1):11-26.
[4]
Hu Q, Wang D, Chen Y, et al. Network meta-analysis comparing neoadjuvant chemoradiation, neoadjuvant chemotherapy and upfront surgery in patients with resectable, borderline resectable, and locally advanced pancreatic ductal adenocarcinoma[J]. Radiat Oncol, 2019, 14(1):120.
[5]
Park W, Chawla A, O'Reilly EM. Pancreatic cancer: a review[J]. JAMA, 2021, 326(9):851-862.
[6]
Klaiber U, Hackert T, Neoptolemos JP. Adjuvant treatment for pancreatic cancer[J]. Transl Gastroenterol Hepatol, 2019, 4:27.
[7]
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer[J]. N Engl J Med, 2004, 350(12):1200-1210.
[8]
Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial[J]. JAMA, 2010, 304(10):1073-1081.
[9]
Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial[J]. JAMA, 2013, 310(14):1473-1481.
[10]
Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4):a multicentre, open-label, randomised, phase 3 trial[J]. Lancet, 2017, 389(10073):1011-1024.
[11]
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer[J]. N Engl J Med, 2018, 379(25):2395-2406.
[12]
Frei E 3rd. Clinical cancer research: an embattled species[J]. Cancer, 1982, 50(10):1979-1992.
[13]
Seufferlein T, Uhl W, Kornmann M, et al. Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer (NEONAX)-a randomized phaseⅡtrial of the AIO pancreatic cancer group[J]. Ann Oncol, 2023, 34(1):91-100.
[14]
Ghaneh P, Palmer D, Cicconi S, et al. Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomised, phase 2 trial[J]. Lancet Gastroenterol Hepatol, 2023, 8(2):157-168.
[15]
Katz MH, Shi Q, Ahmad SA, et al. Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: alliance for clinical trials in oncology trial A021101[J]. JAMA Surg, 2016, 151(8):e161137.
[16]
国家卫生健康委员会办公厅. 胰腺癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(5):1006-1030.
[17]
Nakao A, Kanzaki A, Fujii T, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer[J]. Ann Surg, 2012, 255(1):103-108.
[18]
Groot VP, Rezaee N, Wu W, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma[J]. Ann Surg, 2018, 267(5):936-945.
[19]
Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase Ⅲ PREOPANC trial[J]. J Clin Oncol, 2020, 38(16):1763-1773.
[20]
Motoi F, Satoi S, Honda G, et al. A single-arm, phase Ⅱ trial of neoadjuvant gemcitabine and S1 in patients with resectable and borderline resectable pancreatic adenocarcinoma: prep-01 study[J]. J Gastroenterol, 2019, 54(2):194-203.
[21]
Labori KJ, Lassen K, Hoem D, et al. Neoadjuvant chemotherapy versus surgery first for resectable pancreatic cancer [Norwegian Pancreatic Cancer Trial-1 (NorPACT-1)] - study protocol for a national multicentre randomized controlled trial[J]. BMC Surg, 2017, 17(1):94.
[22]
Motoi F, Kosuge T, Ueno H, et al. Randomized phase Ⅱ/Ⅲ trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05)[J]. Jpn J Clin Oncol, 2019, 49(2):190-194.
[23]
Versteijne E, van Dam JL, Suker M, et al. Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: long-term results of the Dutch randomized PREOPANC trial[J]. J Clin Oncol, 2022, 40(11):1220-1230.
[24]
Rangelova E, Wefer A, Persson S, et al. Surgery improves survival after neoadjuvant therapy for borderline and locally advanced pancreatic cancer: a single institution experience[J]. Ann Surg, 2021, 273(3):579-586.
[25]
Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2):93-99.
[26]
Hackert T, Sachsenmaier M, Hinz U, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients[J]. Ann Surg, 2016, 264(3):457-463.
[27]
Philip PA, Lacy J, Portales F, et al. Nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer (LAPACT):a multicentre, open-label phase 2 study[J]. Lancet Gastroenterol Hepatol, 2020, 5(3):285-294.
[28]
Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer[J]. Ann Surg, 2015, 261(1):12-17.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[3] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[4] 王宇, 徐芳泉, 周旋, 姚晓峰, 李强. 不断提高分化型甲状腺癌根治性切除规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 473-476.
[5] 孙辉, 李长霖. 分化型甲状腺癌根治性切除术中的关键考量与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 477-481.
[6] 张腾花, 尚培中, 王晓梅, 李晓武, 王金, 苗建军, 刘冰. 外伤性脾破裂三阶梯分层治疗策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 510-512.
[7] 高建新, 王啸飞, 于淼, 路夷平. 局部进展期直肠癌新辅助治疗后行ISR术远切缘距离的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 539-543.
[8] 李阳, 董峰, 曾立鹏. 局部进展期直肠癌新辅助治疗后腹腔镜TaTME与TME中的对比研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 547-550.
[9] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[10] 王昌前, 林婷婷, 宁雨露, 王颖杰, 谭文勇. 光免疫治疗在肿瘤领域的临床应用新进展[J]. 中华临床医师杂志(电子版), 2024, 18(06): 575-583.
[11] 张梦婷, 穷拉姆, 色珍, 李逸群, 德庆旺姆. 西藏地区藏族乳腺癌新辅助化疗的真实世界研究[J]. 中华临床医师杂志(电子版), 2024, 18(05): 441-446.
[12] 朱旦华, 卢放根. 以腹水为主要特征的Castleman病16例[J]. 中华临床医师杂志(电子版), 2024, 18(05): 462-473.
[13] 奚培培, 周加军. 慢性肾脏病患者肌少症机制和诊治的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(05): 491-495.
[14] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[15] 孙双权, 孙玮玮, 王勇, 方道成, 温晖. 肾脏混合性上皮和间质肿瘤一例[J]. 中华临床医师杂志(电子版), 2024, 18(05): 512-515.
阅读次数
全文


摘要