Pancreatic cancer

Abstract

Improving the survival of patients with pancreatic ductal adenocarcinoma (PDAC) remains an oncological and surgical challenge. The non-specific nature of presenting symptoms which results in approximately 50% of patients having advanced disease at diagnosis, coupled with its relative chemoresistance have led to persistently poor survival rates. Unfortunately, even long-term outcomes following surgical resection for PDAC remain poor, with only 20% of patients surviving 5 years after pancreatectomy. Patient selection for surgery remains sub-optimal largely due to the absence of consideration of aggressive tumour biology. The benefits of FOLFIRINOX for patients with metastatic disease are now being realized in the adjuvant setting and potentially in the neoadjuvant space coupled with improved understanding of the impact of treatment sensitive molecular subgroups. For all patients with PDAC, management should incorporate multidisciplinary management, and integrated supportive care with comprehensive germline testing becoming increasingly applied. The future will likely see gradual progression to more patient-centred treatment algorithms based on tumour molecular profiling with the aim of improving not only survival outcomes but also quality of life.