Segelov Eva, Lordick Florian, Goldstein David, Chantrill Lorraine A, Croagh Daniel, Lawrence Ben, Arnold Dirk, Chau Ian, Obermannova Radka, Price Timothy Jay
a Department of Oncology , Monash Medical Centre and Monash University , Melbourne , Australia.
b Department of Oncology, University Cancer Center Leipzig , University Medicine Leipzig , Leipzig , Germany.
Expert Rev Anticancer Ther. 2017 Oct;17(10):951-964. doi: 10.1080/14737140.2017.1369882. Epub 2017 Aug 28.
Despite recent progress, the outlook for most patients with pancreatic cancer remains poor. There is variation in how patients are managed globally due to differing interpretations of the evidence, partly because studies in this disease are challenging to undertake. This article collates the evidence upon which current best practice is based and offers an expert opinion from an international faculty on how latest developments should influence current treatment paradigms. Areas covered: Optimal chemotherapy for first and subsequent lines of therapy; optimal management of locally advanced, non-metastatic cancer including the role of neoadjuvant chemo(radio)therapy, current evidence for adjuvant chemotherapy, major advances in pancreatic cancer genomics and challenges in supportive care particularly relevant to patients with pancreatic cancer. For each section, literature was reviewed by comprehensive search techniques, including clinical trial websites and abstracts from international cancer meetings. Expert commentary: For each section, a commentary is provided. Overall the challenges identified were: difficulties in diagnosing pancreatic cancer early, challenges for performing randomised clinical trials in all stages of the disease, some progress in systemic therapy with new agents and in identifying molecular subtypes that may be clinically relevant and move towards personalized therapy, but still, pancreatic cancer remains a very poor prognosis cancer with significant palliative care needs.
尽管最近取得了进展，但大多数胰腺癌患者的预后仍然很差。由于对证据的解释不同，全球范围内患者的治疗方式存在差异，部分原因是针对这种疾病的研究开展起来具有挑战性。本文整理了当前最佳实践所依据的证据，并提供了国际专家团队对于最新进展应如何影响当前治疗模式的专业意见。涵盖领域：一线及后续治疗的最佳化疗方案；局部晚期、非转移性癌症的最佳管理，包括新辅助化疗（放疗）的作用、辅助化疗的现有证据、胰腺癌基因组学的重大进展以及与胰腺癌患者特别相关的支持治疗挑战。对于每个部分，通过全面的检索技术对文献进行了综述，包括临床试验网站和国际癌症会议的摘要。专家评论：针对每个部分都提供了评论。总体而言，所确定的挑战包括：早期诊断胰腺癌存在困难；在疾病的各个阶段进行随机临床试验面临挑战；新药物在全身治疗方面取得了一些进展，在识别可能具有临床相关性并朝着个性化治疗发展的分子亚型方面也有进展，但胰腺癌仍然是一种预后极差的癌症，对姑息治疗有巨大需求。
