Skip to main content

Advertisement

SpringerLink
Log in

Pancreatic ductal adenocarcinoma: metastatic disease

  • Review article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

The treatment of choice of metastatic PADC is systemic chemotherapy. In the last decade, there have been significant advances in this area. New combination poli-chemotherapy schemes have shown a significant increase in overall survival and progression-free survival without impairing quality of life. In addition, the value of second-line chemotherapy treatment has consolidated and a new concept called “therapeutic sequencing” has also emerged. The aim of this article is to review the different therapeutic options in metastatic PDAC based on patient’s characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. http://seer.cancer.gov/statfacts/html/pancreas.html, Accessed Feb 2016.

  2. Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr J, Neoptolemos J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15:8–18.

    Article  PubMed  Google Scholar 

  3. Sener SF, Fremgen A, Menck HR, Winchester D. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg. 1999;189:1–7.

    Article  CAS  PubMed  Google Scholar 

  4. Dykewicz CA. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis. 2001;33:139–44.

    Article  CAS  PubMed  Google Scholar 

  5. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.

    Article  CAS  PubMed  Google Scholar 

  6. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.

    Article  Google Scholar 

  7. Peixoto RD, Ho M, Renouf DJ, Lim HJ, Gill S, Ruan JY, et al. Eligibility of metastatic pancreatic cancer patients for first-line palliative intent nab-paclitaxel plus gemcitabine versus FOLFIRINOX. Am J Clin Oncol. 2015. doi:10.1097/COC.0000000000000193.

  8. Thota R, Pauff JM, Berlin JD. Treatment of metastatic pancreatic adenocarcinoma: a review. Oncology (Williston Park). 2014;28:70–4.

    Google Scholar 

  9. Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013;5:3–29.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chen YG, Pan HH, Dai MS, Kin C, Lu CS, Chang PY, et al. Impact of comorbidity and age on determinants therapeutic strategies in advanced pancreatic head cancer patients with obstructive jaundices. Medicine (Baltimore). 2015;94:e1298.

    Article  Google Scholar 

  11. Venook AP, Egorin MJ, Rosner GL, Hollis D, Mani S, Hawkins M, et al. Phase I and pharmacokinetic trial of gemcitabine in patients with hepatic or renal dysfunction: cancer and Leukemia Group B 9565. J Clin Oncol. 2000;18:2780–7.

    Article  CAS  PubMed  Google Scholar 

  12. Rothenberg ML, Meropol NJ, Poplin EA, Poplin EA, Van Cutsem E, Wadler S, et al. Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: summary findings of an independent panel. J Clin Oncol. 2001;19:3801–71.

    Article  CAS  PubMed  Google Scholar 

  13. Rahma OE, Duffy A, Liewehr DJ, Steinberg SM, Greten TF. Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol. 2013;24:1972–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Oettle H, Riess H, Stieler JM, Heil G, Shwaner I, Seraphin J, et al. Second-line oxaliplatin, folinic acid, and fluorouracil versus folinic acid and fluorouracil alone for gemcitabine-refractory pancreatic cancer: outcomes from the CONKO-003 trial. J Clin Oncol. 2014;32:2423–9.

    Article  CAS  PubMed  Google Scholar 

  15. Gill S, Ko YJ, Cripps C, Beaudoin A, Dhesy-Thind S, Zulfiqar M, et al. PANCREOX: a randomized phase 3 study of 5FU/LV with or without oxaliplatin for second-line advanced pancreatic cancer (APC) in patients (pts) who have received gemcitabine (GEM)-based chemotherapy (CT). J Clin Oncol. 2014;32:A4022.

    Article  Google Scholar 

  16. Chen LT, Von Hoff DD, Li CP, Wang-Gillam A, Bodoky G, Dean AP, et al. Expanded analyses of napoli-1: phase 3 study of MM-398 (nal-IRI), with or without 5-fluorouracil and leucovorin, versus 5-fluorouracil and leucovorin, in metastatic pancreatic cancer (mPAC) previously treated with gemcitabine-based therapy. J Clin Oncol. 2015; 33 S3.

  17. Hosein PJ, de Lima G, Pastorini VH, Gomez C, Macintyre J, Zayas G, Reis I, et al. A phase II trial of nab-paclitaxel as second-line therapy in patients with advanced pancreatic cancer. Am J Clin Oncol. 2013;36:151–6.

    Article  CAS  PubMed  Google Scholar 

  18. Bertocchi P, Abeni C, Meriggi F, Rota K, Rizzi A, Di Biasi B, Aroldi F, et al. Gemcitabine plus nab-paclitaxel as second-line and beyond treatment for metastatic pancreatic cancer: a single institution retrospective analysis. Rev Recent Clin Trials. 2015;10:142–5.

    Article  CAS  PubMed  Google Scholar 

  19. Petrelli F, Borgonovo K, Ghilardi M, Cabiddu M, Barni S. What else in gemcitabine-pretreated advanced pancreatic cancer? An update of second line therapies. Rev Recent Clin Trials. 2010;5:43–56.

    Article  CAS  PubMed  Google Scholar 

  20. Fortune BE, Li X, Kosuri KV, Weatherby LM, Thomas JP, Bekaii Saab TS. Fixed-dose-rate gemcitabine in combination with oxaliplatin in patients with metastatic pancreatic cancer refractory to standard-dose-rate gemcitabine: a single-institute study. Oncology. 2009;76:333–7.

    Article  CAS  PubMed  Google Scholar 

  21. Demols A, Peeters M, Polus M. Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study. Br J Cancer. 2006;94:481–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Reni M, Cereda S, Mazza E, Passoni P. PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine regimen as second-line therapy in patients with progressive or recurrent pancreatic cancer after gemcitabine-containing chemotherapy. Am J Clin Oncol. 2008;31:145–50.

    Article  CAS  PubMed  Google Scholar 

  23. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.

    Article  CAS  PubMed  Google Scholar 

  24. Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.

    Article  CAS  PubMed  Google Scholar 

  25. Ducreaux M, AS Cuhna, Caramella C, Hollebecque A, Burtin D, Goéré D, et al. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;5:v56–68.

    Article  Google Scholar 

  26. Shah MA, Capanu M, Soff G, Asmis T, Kelsen DP. Risk factors for developing a new venous thromboembolism in ambulatory patients with non-hematologic malignancies and impact on survival for gastroesophageal malignancies. J Thromb Haemost. 2010;8:1702–92.

    Article  CAS  PubMed  Google Scholar 

  27. NCCN Guidelines for Myeloid Growth Factor. 2015. Version 2. http://www.tri-kobe.org/nccn/guideline/hematologic/english/myeloid_growth.pdf. Accessed Feb 2016.

  28. NCCN Guidelines for Antiemesis. 2015. Version 2. http://www.prolekare.cz/dokumenty/Antiemetikum_guidelines.pdf. Accessed Feb 2016.

  29. Di Maio M, Bria E, Banna GL, Puglisi F, Garssino MC, Lorusso DP. Prevention of chemotherapy-induced nausea and vomiting and the role of neurokinin 1 inhibitors: from guidelines to clinical practice in solid tumors. Anticancer Drugs. 2013;24:99–111.

    Article  PubMed  Google Scholar 

  30. Qi WX, Lin F, Sun YJ, Tang LN, Shen Z, Yao Y. Risk of venous and arterial thromboembolic events in cancer patients treated with gemcitabine: a systematic review and meta-analysis. Br J Clin Pharmacol. 2013;76:338–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Giordiano G, Milella M, Lo Re G, Di Marco M, Melisi D, Passardi A, et al. Nab paclitaxel (Nab-P) and Gemcitabine (G) first line chemotherapy (CT) in metastatic pancreatic cancer (mPC) patients (pts) relapsed after adjuvant treatment (ADJ T): A “real life” study. J Clin Oncol. 2017;35(Suppl 4S):396. doi:10.1200/JCO.2017.35.4_suppl.396.

Download references

Acknowledgements

The authors thank Sofía Perea, Pharm D, PhD, for her support in writing the manuscript.

Funding

The support for medical writing was supported by Fundación ECO.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain

    A. J. Muñoz Martín

  2. Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain

    J. Adeva

  3. Department of Medical Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain

    J. Martínez-Galán

  4. Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Seville, Spain

    J. J. Reina

  5. Department of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard University, Boston, USA

    M. Hidalgo

Authors
  1. A. J. Muñoz Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Adeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Martínez-Galán
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. J. Reina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Hidalgo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. J. Muñoz Martín.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Muñoz Martín, A.J., Adeva, J., Martínez-Galán, J. et al. Pancreatic ductal adenocarcinoma: metastatic disease. Clin Transl Oncol 19, 1423–1429 (2017). https://doi.org/10.1007/s12094-017-1690-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-017-1690-6

Keywords

Search

Navigation