Institut Curie, Département d’oncologie médicale, Université Versailles Saint-Quentin, 35 rue Dailly, 92210 Saint-Cloud
Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer death by 2030. While overall survival rates at 5 years remains low, significant progress has been made over the last decade. For patients with operable PDAC, adjuvant chemotherapy with FOLFIRINOX has been demonstrated to be superior to gemcitabine. Preoperative treatment strategies (neoadjuvant for upfront resectable tumors, induction for borderline tumors) are currently evaluated in clinical trials. In advanced stages, maintenance treatment strategies after a period of disease control with FOLFIRINOX are emerging. While no targeted therapy had so far shown efficacy in PDAC, PARP inhibitors significantly improved progression-free survival as maintenance therapy in patients with a BRCA germline mutation (5%). Immunotherapies have been disappointing in PDAC, except for tumors with microsatellite instability (1%-2%). Supportive care is central to improving the quality of life of patients. Several national clinical trials (PRODIGE) are in progress. The chapter of the National Thesaurus of Digestive Oncology (TNCD) focusing on PDAC was recently updated (June 2018) to take account of these advances. This review provides an overview of recent practice changes in the medical treatment of PDAC.
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