ESMO E-Learning: Advanced Pancreatic Cancer and Development in Adjuvant Therapy

This comprehensive E-Learning module provides the basics in epidemiology, clinical presentation, diagnosis and disease assessment before treatment. Furthermore, it features recent novelties in the adjuvant setting and management of patients with advanced pancreatic cancer. The author also compiles ongoing research strategies and elaborates the future prospect in the management of pancreatic adenocarcinoma.

The author underlines that at least 150 000 cases/year in Europe and 460 000 new cases with pancreatic cancer were diagnosed in the world in 2018. The main modifiable and main genetic risk factors for pancreatic cancer are illustrated in the module, as well as clinical presentation, diagnosis, disease assessment, staging and classification for resectability (resectable, borderline or locally advanced pancreatic cancer).

Surgery is the only potential curative treatment for pancreatic cancer. The author explains the pre-operative work-up and different types of surgery. However, with surgery alone, relapse rates are reported in 85% to 95% within 5 years. Therefore, a big portion of the module is dedicated to the adjuvant treatment and to the results from recent research efforts, as well as the way to select the good treatment for each patient. The module provides solid messages for clinical practice and it is accompanied by an algorithm for resectable pancreatic cancer and adjuvant therapy.

In terms of locally advanced disease, the author states that most of these patients are metastatic. However, a small percentage may reach curative surgery and potential cure. No significant difference was observed in overall survival with chemoradiotherapy compared to chemotherapy alone. This part of the module is consolidated by an algorithm of treatment for locally advanced pancreatic cancer.

Overall survival remains poor for metastatic pancreatic cancer. The author features the results of recent trials in first- and second-line metastatic setting that are practice changing. Furthermore, the author elaborates new approaches in rare subtypes, particularly in terms of BRCAness and treatment novelties that may impact the clinical practice in the near future, as well as immunotherapy agents in patients with MSI high tumours and tumours with gene fusions. The author also provides an overview of clinical trials in the metastatic setting and urges for the enrolment of patients in clinical trials. Besides future directions, the author highlights the importance of surveillance, thus providing comprehensive teaching material.