From the Guidelines
The most effective treatment for pancreatic adenocarcinoma is complete surgical resection, which is the only potentially curative treatment available, as stated in the most recent and highest quality study 1.
Diagnosis and Staging
Pancreatic adenocarcinoma tissue refers to cancerous tissue originating from the exocrine cells of the pancreas, which is the most common form of pancreatic cancer. This tissue is characterized by abnormal glandular structures with malignant epithelial cells that produce mucin. When examining pancreatic adenocarcinoma tissue, pathologists typically observe a dense desmoplastic (fibrotic) reaction surrounding the cancer cells, which is a hallmark feature of this cancer type. The tissue often shows varying degrees of differentiation, from well-differentiated tumors that resemble normal pancreatic ductal structures to poorly differentiated tumors with minimal resemblance to normal tissue. Molecular analysis of this tissue commonly reveals mutations in KRAS (in about 90% of cases), as well as alterations in TP53, CDKN2A, and SMAD4 genes. These genetic changes drive the aggressive behavior of pancreatic adenocarcinoma, contributing to its poor prognosis and resistance to many therapies. Proper handling and analysis of pancreatic adenocarcinoma tissue is crucial for accurate diagnosis, staging, and treatment planning.
Treatment Options
The treatment of pancreatic adenocarcinoma depends on the stage of the disease. For resectable tumors, complete surgical resection is the primary treatment option, with adjuvant chemotherapy and/or radiotherapy considered in some cases 1. For locally advanced or metastatic disease, chemotherapy and/or radiotherapy are the primary treatment options, with a focus on palliative care and symptom management 1.
Key Considerations
Some key considerations in the treatment of pancreatic adenocarcinoma include:
- The importance of accurate staging and diagnosis to determine the best course of treatment 1
- The role of surgical resection in the treatment of resectable tumors 1
- The use of adjuvant chemotherapy and/or radiotherapy in the treatment of resectable tumors 1
- The focus on palliative care and symptom management in the treatment of locally advanced or metastatic disease 1
Recent Guidelines
Recent guidelines from the National Comprehensive Cancer Network (NCCN) recommend that patients with resectable pancreatic adenocarcinoma undergo surgical resection followed by adjuvant therapy, while patients with borderline resectable disease may undergo neoadjuvant therapy to improve the chances of an R0 resection 1. The guidelines also emphasize the importance of accurate staging and diagnosis, as well as the use of multidisciplinary care teams to manage the complex needs of patients with pancreatic adenocarcinoma.
From the FDA Drug Label
4 Pancreatic Cancer Gemcitabine Injection is indicated as first-line treatment for patients with locally advanced (nonresectable Stage II or Stage III) or metastatic (Stage IV) adenocarcinoma of the pancreas.
5 Recommended Dosage for Pancreatic Adenocarcinoma • The recommended dose of fluorouracil, administered as an infusional regimen in combination with leucovorin or as a component of a multidrug chemotherapy regimen that includes leucovorin, is 400 mg/m2 intravenous bolus on Day 1, followed by 2400 mg/m2 intravenously as a continuous infusion over 46 hours every two weeks.
Gemcitabine and fluorouracil are indicated for the treatment of pancreatic adenocarcinoma.
- Gemcitabine is indicated as a first-line treatment for patients with locally advanced or metastatic pancreatic adenocarcinoma 2.
- Fluorouracil is recommended as an infusional regimen in combination with leucovorin for the treatment of pancreatic adenocarcinoma, with a dose of 400 mg/m2 intravenous bolus on Day 1, followed by 2400 mg/m2 intravenously as a continuous infusion over 46 hours every two weeks 3.
From the Research
Pancreatic Adenocarcinoma Tissue
- Pancreatic adenocarcinoma is a type of cancer that can be treated with various chemotherapy regimens, including FOLFIRINOX and gemcitabine plus nab-paclitaxel 4, 5, 6, 7.
- Studies have shown that FOLFIRINOX is associated with higher rates of RECIST partial response and subsequent pancreatectomy than gemcitabine plus nab-paclitaxel, but the overall survival associated with these regimens is similar 4.
- Neoadjuvant treatment with gemcitabine plus nab-paclitaxel has been shown to be effective in down-staging tumors and achieving negative surgical margins in patients with borderline resectable or node-positive pancreatic ductal adenocarcinoma 5, 7.
- Maintenance chemotherapy with capecitabine has been shown to be safe and effective in patients with pancreatic ductal adenocarcinoma who have responded to induction treatment with FOLFIRINOX or gemcitabine/nab-paclitaxel 8.
Treatment Options
- FOLFIRINOX: a chemotherapy regimen that includes fluorouracil, leucovorin, irinotecan, and oxaliplatin 4.
- Gemcitabine plus nab-paclitaxel: a chemotherapy regimen that includes gemcitabine and nanoparticle albumin-bound paclitaxel 4, 5, 6, 7.
- Capecitabine: an oral formulation of 5-fluorouracil that can be used as maintenance therapy in patients with pancreatic ductal adenocarcinoma 8.
Clinical Trials
- A phase 2 study of preoperative chemotherapy with nab-paclitaxel and gemcitabine followed by chemoradiation for borderline resectable or node-positive pancreatic ductal adenocarcinoma showed that this regimen is feasible and effective 5.
- A multicentre, open-label phase 2 study of nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer showed that this regimen is tolerable and active, with a potential to convert unresectable disease to surgically resectable disease 6.
- A phase I study of preoperative chemotherapy with gemcitabine plus nab-paclitaxel for resectable pancreatic cancer showed that this regimen is safe and feasible at dose level 1 7.