Progress and prospects of systemic treatment for pancreatic cancer with distant metastasis

doi:10.3877/cma.j.issn.2095-3232.2024.05.010

Abstract

Abstract:

At present, the overall clinical efficacy of pancreatic cancer is poor. Systemic therapies, such as chemotherapy, targeted therapy and immunotherapy, are the main treatment methods for pancreatic cancer complicated with distant metastasis. Since gemcitabine and fluorouracil have been used as the main drugs in pancreatic cancer, the application of new dosage forms, such as albumin-bound paclitaxel and irinotecan-loaded liposome, has improved the therapeutic effect of pancreatic cancer. AG and FOLFIRINOX regimens are the standard first-line treatments for metastatic pancreatic cancer. As an optimized version of FOLFIRINOX regimen, high-quality evidence of NALIRIFOX regimen has been recognized and considered as the first-line regimen in the latest NCCN guideline. In terms of targeted therapy, the exact efficacy of PARP inhibitors provides a better strategy for maintenance treatment of patients with BRCA1/2-mutant pancreatic cancer. The introduction of KRAS G12C inhibitors brings confidence and hope to the drug research and development for patients with advanced pancreatic cancer and other mutation sites of KRAS. Currently, immunotherapy is an important breakthrough direction of tumor research mainly by converting immune cold tumors into immune hot tumors and expanding the applicable populations of immune checkpoint inhibitors. In addition, novel immunotherapies, such as CAR-T therapy, TCR-T therapy and mRNA vaccine, are being investigated. Multiple in-depth explorations and innovative therapies have brought hope for the survival of patients with advanced pancreatic cancer. Clinicians should work closely with basic medicine experts and drug research and development scientists to accelerate the development and application of new drugs or new therapies in refractory pancreatic cancer.

Key words: Pancreatic neoplasms, Pancreatic duct adenocarcinoma, Systematic therapy, Chemotherapy, Targeted therapy, Immunotherapy

Miaoyan Wei, Jin Xu. Progress and prospects of systemic treatment for pancreatic cancer with distant metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 644-650.

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