胰腺癌治疗的共识、争论和展望。

IF 29.5 1区 医学 Q1 HEMATOLOGY
Junke Wang, Jie Yang, Amol Narang, Jin He, Christopher Wolfgang, Keyu Li, Lei Zheng
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引用次数: 0

摘要

胰腺癌仍然是侵袭性最强的实体肿瘤之一。作为一种全身性疾病,尽管多模式治疗策略不断改进,但胰腺癌的预后并未得到显著改善。对于可切除或边缘可切除患者,以提高 R0 切除率为中心的手术策略已成为共识;然而,新辅助治疗在可切除患者中的作用,以及化疗联合或不联合放疗的最佳新辅助治疗在边缘可切除患者中的作用却存在争议。无论边缘状态如何,均建议术后辅助化疗吉西他滨/卡培他滨或 mFOLFIRINOX。化疗作为晚期或转移性患者的一线治疗策略,包括FOLFIRINOX、吉西他滨/纳布紫杉醇或NALIRIFOX方案,而5-FU加脂质体伊立替康是唯一的二线标准疗法。免疫疗法是一种创新疗法,尽管抗PD-1抗体是目前唯一获准用于MSI-H、dMMR或TMB-高实体瘤的药物,而这些肿瘤只占胰腺癌的极小一部分。增加免疫原性和克服免疫抑制性肿瘤微环境的组合策略可能会使胰腺癌对免疫疗法敏感。以 PARP 和 KRAS 抑制剂为代表的靶向疗法也在研究之中,这些疗法在改善无进展生存期和客观反应率方面显示出了优势。本综述讨论了当前的治疗模式,并重点介绍了胰腺癌的创新疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Consensus, debate, and prospective on pancreatic cancer treatments.

Pancreatic cancer remains one of the most aggressive solid tumors. As a systemic disease, despite the improvement of multi-modality treatment strategies, the prognosis of pancreatic cancer was not improved dramatically. For resectable or borderline resectable patients, the surgical strategy centered on improving R0 resection rate is consensus; however, the role of neoadjuvant therapy in resectable patients and the optimal neoadjuvant therapy of chemotherapy with or without radiotherapy in borderline resectable patients were debated. Postoperative adjuvant chemotherapy of gemcitabine/capecitabine or mFOLFIRINOX is recommended regardless of the margin status. Chemotherapy as the first-line treatment strategy for advanced or metastatic patients included FOLFIRINOX, gemcitabine/nab-paclitaxel, or NALIRIFOX regimens whereas 5-FU plus liposomal irinotecan was the only standard of care second-line therapy. Immunotherapy is an innovative therapy although anti-PD-1 antibody is currently the only agent approved by for MSI-H, dMMR, or TMB-high solid tumors, which represent a very small subset of pancreatic cancers. Combination strategies to increase the immunogenicity and to overcome the immunosuppressive tumor microenvironment may sensitize pancreatic cancer to immunotherapy. Targeted therapies represented by PARP and KRAS inhibitors are also under investigation, showing benefits in improving progression-free survival and objective response rate. This review discusses the current treatment modalities and highlights innovative therapies for pancreatic cancer.

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来源期刊
CiteScore
48.10
自引率
2.10%
发文量
169
审稿时长
6-12 weeks
期刊介绍: The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.
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