Current challenges in optimizing systemic therapy for patients with pancreatic cancer: expert perspectives from the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty

ABSTRACT

Introduction: Despite recent progress, the outlook for most patients with pancreatic cancer remains poor. There is variation in how patients are managed globally due to differing interpretations of the evidence, partly because studies in this disease are challenging to undertake. This article collates the evidence upon which current best practice is based and offers an expert opinion from an international faculty on how latest developments should influence current treatment paradigms.

Areas covered: Optimal chemotherapy for first and subsequent lines of therapy; optimal management of locally advanced, non-metastatic cancer including the role of neoadjuvant chemo(radio)therapy, current evidence for adjuvant chemotherapy, major advances in pancreatic cancer genomics and challenges in supportive care particularly relevant to patients with pancreatic cancer. For each section, literature was reviewed by comprehensive search techniques, including clinical trial websites and abstracts from international cancer meetings.

Expert commentary: For each section, a commentary is provided. Overall the challenges identified were: difficulties in diagnosing pancreatic cancer early, challenges for performing randomised clinical trials in all stages of the disease, some progress in systemic therapy with new agents and in identifying molecular subtypes that may be clinically relevant and move towards personalized therapy, but still, pancreatic cancer remains a very poor prognosis cancer with significant palliative care needs.

KEYWORDS:

• Pancreatic cancer
• chemotherapy
• prognosis
• palliation
• adjuvant

Acknowledgments

I Chau would like to acknowledge National Health Service funding to the National Institute for Health Research Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research.

Declaration of interest

E Segelov has sat on advisory boards for Merck Serono, Roche, and Ipsen and has received travel expenses from Merck Serono. D Goldstein has received research funding from Amgen and Celgene. LA Chantrill has acted in an advisory capacity to Shire Pty Ltd. D Arnold has received honorarium from Bayer, Merck, Roche, Sanofi, Servier, and Eli-Lilly. F Lordick has received personal fees from Amgen, Astra Zeneca, Biontech, Bristol-Myers Squibb, Ganymed, Eli Lilly, MSD, Nordic, Roche and Taiho, and reports non-financial support from Boston Biomedical and grants from Fresenius Biotech. I Chau has sat on the advisory board for Sanofi Oncology, Eli-Lilly, Bristol Myers Squibb, MSD, Bayer, Roche and Five Prime Therapeutics. He also declares research funding from Janssen-Cilag, Sanofi Oncology, Merck-Serono, and Novartis and honorarium from Taiho, Pfizer, Amgen, and Eli-Lilly. B Lawrence has previously received research funding from Novartis, accommodation support from Roche and MSD, and honoraria from Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This activity was supported by an unrestricted educational grant to The Australasian Gastrointestinal Trial Group (AGITG) from Shire Pty Ltd. The scope, content and conduct of the expert meeting and production of this report was entirely independent from any input by Shire Pty Ltd or any other company. I Chau would like to acknowledge National Health Service funding to the National Institute for Health Research Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research.