Recent advances in chemotherapy for pancreatic cancer: evidence from Japan and recommendations in guidelines

Abstract

The prognosis of patients with pancreatic cancer continues to remain dismal, even though numerous trials have been conducted to establish more effective therapies in Japan and throughout the world. Recent advances in treatment have been characterized by the use of novel combinations of conventional cytotoxic chemotherapies. Especially in Japan, S-1 has become one of the most widely used cytotoxic agents for the treatment of pancreatic cancer, after clinical evidence was established of the survival benefit offered by this drug for patients with resectable or unresectable pancreatic cancer. Unfortunately, with the exception of erlotinib, no targeted treatment strategies have been approved for pancreatic cancer. However, following an increase in interest in drug development in recent years, proactive attempts have been made to develop new therapeutic strategies, including neoadjuvant chemotherapy for patients with resectable or borderline resectable pancreatic cancer, multi-agent combination chemotherapy for patients with advanced pancreatic cancer, and therapies with new targeted agents or immuno-oncologic agents for patients with pancreatic cancer bearing specific gene mutations.

Keywords: Actionable mutation; Adjuvant therapy; Immunotherapy; Pancreatic ductal adenocarcinoma; Targeted therapy.

Fig. 1

Algorithm for the treatment of pancreatic cancer according to the Clinical Practice Guidelines for Pancreatic Cancer 2019 from the Japan Pancreas Society. The clinical cancer stage (cStage) classification and resectability classification are based on the General Rules for the Study of Pancreatic Cancer, Seventh Edition, The Japan Pancreas Society

Fig. 2

Algorithm for chemotherapy of pancreatic cancer according to the Clinical Practice Guidelines for Pancreatic Cancer 2019 published by the Japan Pancreas Society. GEM gemcitabine, nab-PTX nab-paclitaxel, FF fluorouracil + calcium folinate