Gastroenterology and GI Oncology, HEGP, APHP, Paris, France; Université de Paris, Faculté de Médecine Paris Descartes, Paris, France.
Gastroenterology and GI Oncology, HEGP, APHP, Paris, France.
ESMO Open. 2020 Aug;4(Suppl 2):e000818. doi: 10.1136/esmoopen-2020-000818.
Pancreatic adenocarcinoma (PA) represents 90% of solid pancreatic malignant tumours. With one of the worst prognoses in oncology (all stages 5-year overall survival (OS) of 9%), PA was the seventh-leading cause of cancer-related deaths worldwide in 2018, and during the last 20 years, there have been unexplained increases in its incidence and mortality.This article summarises how to manage, to our opinion, PA in everyday practice according to tumour staging into resectable, unresectable or metastatic disease. Surgery followed by consensual adjuvant chemotherapy is the first-intention treatment for resectable patients. Unresectable but non-metastatic PA should be treated with induction chemotherapy and optionally with chemoradiotherapy to enable when possible secondary surgical resection. First-line and second-line chemotherapy does improve quality of life and OS in the metastatic setting, FOLFIRINOX and gemcitabine + nab-paclitaxel being the two current standard first-line options. Molecular profiling of metastatic patients is emerging, as some personalised therapies are possible for rare subtypes such as MSI high, BRCA1-2 mutated and NRG1/NTRK fusion gene PA.
胰腺导管腺癌（PA）占胰腺实体恶性肿瘤的 90%。PA 的预后在肿瘤学中是最差的（所有分期 5 年总生存率（OS）为 9%），2018 年是全球第七大癌症相关死亡原因，在过去 20 年中，其发病率和死亡率都出现了无法解释的上升。本文总结了我们根据肿瘤分期（可切除、不可切除或转移性疾病）对日常实践中 PA 的管理方法。可切除患者的首选治疗方法是手术联合共识辅助化疗。不可切除但无转移的 PA 应采用诱导化疗和/或放化疗，以在可能的情况下进行二次手术切除。转移性疾病的一线和二线化疗确实可以提高生活质量和 OS，FOLFIRINOX 和吉西他滨+白蛋白紫杉醇联合nab-紫杉醇是目前两种标准的一线治疗选择。转移性患者的分子谱正在出现，因为对于 MSI 高、BRCA1-2 突变和 NRG1/NTRK 融合基因 PA 等罕见亚型，可能存在一些个性化治疗方法。
