Current systemic treatment for pancreatic cancer

Pancreatic cancer is still difficult to treat, and despite some progress in recent years, especially the development of combination chemotherapy, the prognosis remains dismal. Chemotherapy is recommended for every patient that is fit enough: after curative resection, adjuvant chemotherapy can increase disease-free and 5-year survival. In patients with metastases, palliative chemotherapy can improve survival and quality of life. In patients with borderline resectable tumors, short-course chemotherapy can improve survival without necessarily affecting resectability. In patients with locally advanced cancer, induction chemotherapy can result in secondary resectability. In contrast to most other types of cancer there is no role for immunotherapy yet, but new strategies are being investigated in clinical trials. There have been advances in targeted therapy, but these are limited to the few patients with BRCA germline mutations, KRAS wildtype or the rare KRAS G12C mutations. Further progress, for example, for patients with other KRAS mutations can be expected in the coming years. A better understanding of the molecular resistance mechanisms in the individual patient against chemotherapy, immunotherapy and targeted therapy will be necessary to further improve systemic therapy in the future.