University Medical Center Ulm, Ulm, Germany.
Hôpital Beaujon (AP-HP), Clichy, and Université Paris VII-Denis Diderot, France.
Cancer Treat Rev. 2019 Jul;77:1-10. doi: 10.1016/j.ctrv.2019.05.007. Epub 2019 May 29.
Surgical resection of pancreatic cancer offers a chance of cure, but currently only 15-20% of patients are diagnosed with resectable disease, while 30-40% are diagnosed with non-metastatic, unresectable locally advanced pancreatic cancer (LAPC). Treatment for LAPC usually involves systemic chemotherapy, with the aim of controlling disease progression, reducing symptoms and maintaining quality of life. In a small proportion of patients with LAPC, primary chemotherapy may successfully convert unresectable tumours to resectable tumours. In this setting, primary chemotherapy is termed 'induction therapy' rather than 'neoadjuvant'. There is currently a lack of data from randomized studies to thoroughly evaluate the benefits of induction chemotherapy in LAPC, but Phase II and retrospective data have shown improved survival and high R0 resection rates. New chemotherapy regimens such as nab-paclitaxel + gemcitabine and FOLFIRINOX have demonstrated improvement in overall survival for metastatic disease and shown promise as neoadjuvant treatment in patients with resectable and borderline resectable disease. Prospective trials are underway to evaluate these regimens further as induction therapy in LAPC and preliminary data indicate a beneficial effect of FOLFIRINOX in this setting. Further research into optimal induction schedules is needed, as well as guidance on the patients who are most suitable for induction therapy. In this expert opinion article, a panel of surgeons, medical oncologists and gastrointestinal oncologists review the available evidence on management strategies for LAPC and provide their recommendations for patient care, with a particular focus on the use of induction chemotherapy.
胰腺癌的手术切除提供了治愈的机会，但目前只有 15-20%的患者被诊断为可切除疾病，而 30-40%的患者被诊断为无转移、不可切除的局部晚期胰腺癌（LAPC）。LAPC 的治疗通常包括全身化疗，目的是控制疾病进展、减轻症状和维持生活质量。在一小部分 LAPC 患者中，原发性化疗可能会成功地将不可切除的肿瘤转化为可切除的肿瘤。在这种情况下，原发性化疗被称为“诱导治疗”而不是“新辅助治疗”。目前，缺乏来自随机研究的充分数据来全面评估诱导化疗在 LAPC 中的益处，但 II 期和回顾性数据显示，诱导化疗可改善生存和高 R0 切除率。新的化疗方案，如nab-紫杉醇+吉西他滨和 FOLFIRINOX，已显示出转移性疾病的总生存改善，并有望成为可切除和边缘可切除疾病患者的新辅助治疗。正在进行前瞻性试验，以进一步评估这些方案作为 LAPC 的诱导治疗，初步数据表明 FOLFIRINOX 在这种情况下具有有益的效果。需要进一步研究最佳诱导方案，并指导最适合诱导治疗的患者。在这篇专家意见文章中，一组外科医生、肿瘤内科医生和胃肠肿瘤学家回顾了 LAPC 管理策略的现有证据，并就患者护理提出了建议，特别关注诱导化疗的使用。
