Systemic treatment of metastatic pancreatic cancer: current standards and perspectives

BackgroundMetastatic pancreatic cancer still has avery poor prognosis with a5-year survival of <5% and remains atherapeutic challenge. In recent years some progress in the systemic treatment could be achieved.ObjectiveThis article presents an overview of the current standards and perspectives in the systemic treatment of metastatic pancreatic cancer.Material and methodsThis review is based on aselective search of the literature in the PubMed database and analysis of the current German guidelines of the Association of the Scientific Medical Societies in Germany (AWMF, S3 guidelines on exocrine pancreatic cancer) and of the German Society for Hematology and Medical Oncology (DGHO, onkopedia guidelines on pancreatic cancer).ResultsIn recent years an improvement in treatment possibilities has been achieved by the use of different combination chemotherapies (FOLFIRINOX, gemcitabin/nab-paclitaxel, liposomal irinotecan+5-FU/folic acid, oxaliplatin+5-FU/folic acid, gemcitabin/erlotinib). Approved substances for the first-line and second-line treatment are gemcitabin, nab-paclitaxel, erlotinib and liposomal irinotecan. No targeted therapy or biomarker-driven treatment strategy in terms of apersonalized therapy could so far be established in the clinical routine.ConclusionsThe optimal sequence and duration of the different available combination chemotherapies of metastatic pancreatic cancer still needs to be defined and are part of current study concepts. The implementation of stroma depletion, immunotherapy and biomarker-based personalized treatment strategies are the subject of ongoing clinical research.