Treatment strategies for different types of pancreatic cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Yang ,  SUN Shaolong

Department of Pancreatic Endocrinology, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, P. R. China;

Corresponding author：

SUN Shaolong, Email: unsl@sj-hospital.org

Keywords：

pancreatic cancer; classification; adjuvant therapy; neoadjuvant therapy; review

DOI：

10.7507/1007-9424.201902010

Video：

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Objective To explore the treatment strategies of different types of pancreatic cancer.Methods By reading the relevant literatures on the treatment of pancreatic cancer at home and abroad in recent years, the classification of pancreatic cancer and the progress of treatment measures were summarized.Results According to preoperative imaging evaluation, pancreatic cancer was divided into resectable pancreatic cancer, borderline resectable pancreatic cancer, locally advanced pancreatic cancer, and pancreatic cancer with distant metastasis. Resection of pancreatic cancer should be radical resection, supplemented with chemotherapy after surgery; patients with resected pancreatic cancer in the junction, if the patient with venous invasion could be resected and reconstructed, it was recommended to undergo surgery and postoperative adjuvant chemotherapy. Patients with unresectable reconstruction and arterial invasion should undergo neoadjuvant therapy, and then re-evaluate the resectability of the tumor to determine whether surgery was feasible. Patients with locally advanced or combined metastatic pancreatic cancer had lost the opportunity for surgery, for this kind of patient, advocated neoadjuvant chemoradiotherapy or second-line combined targeted therapy.Conclusions Most patients with pancreatic cancer have progressed to the stage of clinical diagnosis. They are familiar with the treatment of different types of pancreatic cancer and take targeted treatment measures to improve the survival time of patients.

Citation： PENG Yang, SUN Shaolong. Treatment strategies for different types of pancreatic cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 1011-1015. doi: 10.7507/1007-9424.201902010 Copy

1.	Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin, 2016, 66(4): 271-289.
2.	Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet, 2011, 378(9791): 607-620.
3.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
4.	Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017, 15(8): 1028-1061.
5.	Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery, 2014, 156(3): 591-600.
6.	中华医学会外科学分会胰腺外科学组. 胰腺癌诊治指南(2014 版). 中华消化外科杂志, 2014, 13(11): 831-837.
7.	沈柏用, 施昱晟. 达芬奇机器人手术系统辅助胰腺手术的现状与展望. 中华消化外科杂志, 2017, 16(8): 797-799.
8.	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. JAMA, 2013, 310(14): 1473-1481.
9.	Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol, 2017, 35(20): 2324-2328.
10.	Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(21): 2541-2556.
11.	Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA+/CA125+/CA19-9 ≥ 1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9): 2216-2227.
12.	Merchant NB, Rymer J, Koehler EA, et al. Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits? J Am Coll Surg, 2009, 208(5): 829-838.
13.	Tzeng CW, Fleming JB, Lee JE, et al. Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Ann Surg Oncol, 2012, 19(6): 2045-2053.
14.	Isaji S, Mizuno S, Windsor JA, et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology, 2018, 18(1): 2-11.
15.	Vennin C, Murphy KJ, Morton JP, et al. Reshaping the tumor stroma for treatment of pancreatic cancer. Gastroenterology, 2018, 154(4): 820-838.
16.	Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
17.	Jegatheeswaran S, Baltatzis M, Jamdar S, et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford), 2017, 19(6): 483-490.
18.	Hicks CW, Burkhart RA, Weiss MJ, et al. Management of type 9 hepatic arterial anatomy at the time of pancreaticoduodenectomy: considerations for preservation and reconstruction of a completely replaced common hepatic artery. J Gastrointest Surg, 2016, 20(7): 1400-1404.
19.	Satoi S, Yamaue H, Kato K, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci, 2013, 20(6): 590-600.
20.	Roland CL, Yang AD, Katz MH, et al. Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer. Ann Surg Oncol, 2015, 22(4): 1168-1175.
21.	Youngwirth LM, Nussbaum DP, Thomas S, et al. Nationwide trends and outcomes associated with neoadjuvant therapy in pancreatic cancer: an analysis of 18 243 patients. J Surg Oncol, 2017, 116(2): 127-132.
22.	Dholakia AS, Hacker-Prietz A, Wild AT, et al. Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships. J Radiat Oncol, 2013, 2(4): 413-425.
23.	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. Ann Surg, 2015, 261(1): 12-17.
24.	Festa V, Andriulli A, Valvano MR, et al. Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: a meta-analytical evaluation of prospective studies. JOP, 2013, 14(6): 618-625.
25.	Lowery MA, Yu KH, Adel NG, et al. Activity of front-line FOLFIRINOX (FFX) in stage Ⅲ/Ⅳ pancreatic adenocarcinoma (PC) at Memorial Sloan-Kettering Cancer Center (MSKCC). ASCO Meeting Abstracts, 2012: 4057.
26.	Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet, 2016, 388(10041): 248-257.
27.	Balaban EP, Mangu PB, Khorana AA, et al. Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(22): 2654-2668.
28.	Lal A, Christians K, Evans DB. Management of borderline resectable pancreatic cancer. Surg Oncol Clin N Am, 2010, 19(2): 359-370.
29.	Hackert T, Strobel O, Michalski CW, et al. The TRIANGLE operation-radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford), 2017, 19(11): 1001-1007.
30.	Kawai M, Hirano S, Yamaue H. Artery-first approach for pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2018, 25(6): 319-320.
31.	Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med, 2013, 369(18): 1691-1703.
32.	Wang-Gillam A, Li CP, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet, 2016, 387(10018): 545-557.
33.	Rahma OE, Duffy A, Liewehr DJ, et al. Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol, 2013, 24(8): 1972-1979.
34.	Sahin IH, Askan G, Hu ZI, et al. Immunotherapy in pancreatic ductal adenocarcinoma: an emerging entity? Ann Oncol, 2017, 28(12): 2950-2961.
35.	Feng M, Xiong G, Cao Z, et al. PD-1/PD-L1 and immunotherapy for pancreatic cancer. Cancer Lett, 2017, 407: 57-65.
36.	Hurt CN, Falk S, Crosby T, et al. Long-term results and recurrence patterns from SCALOP: a phase Ⅱ randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer, 2017, 116(10): 1264-1270.
37.	Hackert T, Sachsenmaier M, Hinz U, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients. Ann Surg, 2016, 264(3): 457-463.
38.	Xie D, Xie K. Pancreatic cancer stromal biology and therapy. Genes Dis, 2015, 2(2): 133-143.
39.	Kamimura K, Yokoo T, Terai S. Gene therapy for pancreatic diseases: current status. Int J Mol Sci, 2018, 19(11): E3415.

1. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin, 2016, 66(4): 271-289.
2. Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet, 2011, 378(9791): 607-620.
3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
4. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017, 15(8): 1028-1061.
5. Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery, 2014, 156(3): 591-600.
6. 中华医学会外科学分会胰腺外科学组. 胰腺癌诊治指南(2014 版). 中华消化外科杂志, 2014, 13(11): 831-837.
7. 沈柏用, 施昱晟. 达芬奇机器人手术系统辅助胰腺手术的现状与展望. 中华消化外科杂志, 2017, 16(8): 797-799.
8. 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. JAMA, 2013, 310(14): 1473-1481.
9. Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol, 2017, 35(20): 2324-2328.
10. Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(21): 2541-2556.
11. Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA+/CA125+/CA19-9 ≥ 1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9): 2216-2227.
12. Merchant NB, Rymer J, Koehler EA, et al. Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits? J Am Coll Surg, 2009, 208(5): 829-838.
13. Tzeng CW, Fleming JB, Lee JE, et al. Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Ann Surg Oncol, 2012, 19(6): 2045-2053.
14. Isaji S, Mizuno S, Windsor JA, et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology, 2018, 18(1): 2-11.
15. Vennin C, Murphy KJ, Morton JP, et al. Reshaping the tumor stroma for treatment of pancreatic cancer. Gastroenterology, 2018, 154(4): 820-838.
16. Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg, 2012, 36(4): 884-891.
17. Jegatheeswaran S, Baltatzis M, Jamdar S, et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford), 2017, 19(6): 483-490.
18. Hicks CW, Burkhart RA, Weiss MJ, et al. Management of type 9 hepatic arterial anatomy at the time of pancreaticoduodenectomy: considerations for preservation and reconstruction of a completely replaced common hepatic artery. J Gastrointest Surg, 2016, 20(7): 1400-1404.
19. Satoi S, Yamaue H, Kato K, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci, 2013, 20(6): 590-600.
20. Roland CL, Yang AD, Katz MH, et al. Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer. Ann Surg Oncol, 2015, 22(4): 1168-1175.
21. Youngwirth LM, Nussbaum DP, Thomas S, et al. Nationwide trends and outcomes associated with neoadjuvant therapy in pancreatic cancer: an analysis of 18 243 patients. J Surg Oncol, 2017, 116(2): 127-132.
22. Dholakia AS, Hacker-Prietz A, Wild AT, et al. Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships. J Radiat Oncol, 2013, 2(4): 413-425.
23. 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. Ann Surg, 2015, 261(1): 12-17.
24. Festa V, Andriulli A, Valvano MR, et al. Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: a meta-analytical evaluation of prospective studies. JOP, 2013, 14(6): 618-625.
25. Lowery MA, Yu KH, Adel NG, et al. Activity of front-line FOLFIRINOX (FFX) in stage Ⅲ/Ⅳ pancreatic adenocarcinoma (PC) at Memorial Sloan-Kettering Cancer Center (MSKCC). ASCO Meeting Abstracts, 2012: 4057.
26. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet, 2016, 388(10041): 248-257.
27. Balaban EP, Mangu PB, Khorana AA, et al. Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(22): 2654-2668.
28. Lal A, Christians K, Evans DB. Management of borderline resectable pancreatic cancer. Surg Oncol Clin N Am, 2010, 19(2): 359-370.
29. Hackert T, Strobel O, Michalski CW, et al. The TRIANGLE operation-radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford), 2017, 19(11): 1001-1007.
30. Kawai M, Hirano S, Yamaue H. Artery-first approach for pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2018, 25(6): 319-320.
31. Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med, 2013, 369(18): 1691-1703.
32. Wang-Gillam A, Li CP, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet, 2016, 387(10018): 545-557.
33. Rahma OE, Duffy A, Liewehr DJ, et al. Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol, 2013, 24(8): 1972-1979.
34. Sahin IH, Askan G, Hu ZI, et al. Immunotherapy in pancreatic ductal adenocarcinoma: an emerging entity? Ann Oncol, 2017, 28(12): 2950-2961.
35. Feng M, Xiong G, Cao Z, et al. PD-1/PD-L1 and immunotherapy for pancreatic cancer. Cancer Lett, 2017, 407: 57-65.
36. Hurt CN, Falk S, Crosby T, et al. Long-term results and recurrence patterns from SCALOP: a phase Ⅱ randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer, 2017, 116(10): 1264-1270.
37. Hackert T, Sachsenmaier M, Hinz U, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients. Ann Surg, 2016, 264(3): 457-463.
38. Xie D, Xie K. Pancreatic cancer stromal biology and therapy. Genes Dis, 2015, 2(2): 133-143.
39. Kamimura K, Yokoo T, Terai S. Gene therapy for pancreatic diseases: current status. Int J Mol Sci, 2018, 19(11): E3415.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment strategies for different types of pancreatic cancer

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