John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Locally advanced pancreatic cancer: A heterogeneity of situations to be understood! Volume 29, issue 4, April 2022

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Author
CHU de Saint-Étienne, Service d’hépato-gastro-entérologie, Avenue Albert Raimond, 42270 Saint-Priest-en-Jarez
* Correspondance : N. Williet

Pancreatic cancer is diagnosed in a locally advanced setting in approximately 30% of cases. Despite this, literature remains limited and confused by a great heterogeneity of situations ranging from a potentially resectable tumor (one single artery involved) to a “never resectable” tumor (wide spreading infiltration). In addition, there is still frequently a mix with metastatic disease or borderline tumors in the ongoing phase II-III trials. The thoraco-abdomino-pelvic CT scan with pancreatic phase remains the reference for the evaluation of resectability. NCCN criteria must be applied. Liver MRI is also required to detect possible micrometastases. Pancreatic pain and CA19-9 are increasingly taken into account in this definition. Chemotherapy is the standard of care. Folfirinox should be used for potentially resectable tumors and will probably be the new standard for never resectable tumors (results from Neopan trial are expected). Gemcitabine/nab-paclitaxel seems a good alternative for neoadjuvant treatment (Neolap study is ongoing). Finally, despite a negative phase III trial regarding overall survival, consolidation or neoadjuvant radiochemotherapy continues to be assessed in the area of folfirinox. A better selection of patients is essential to evaluate the potential benefit of locoregional treatments. This requires a better identification of micrometastatic diseases. The use of circulating tumor DNA may help in this selection.