Safety of palliative chemotherapy in advanced pancreatic cancer

ABSTRACT

Introduction: Pancreatic cancer is a major health burden. Currently, the majority of patients is diagnosed at advanced stages and thus qualifies for palliative chemotherapy. Gemcitabine monotherapy has been the gold standard for many years. Recently, more effective chemotherapeutic regimens have shown meaningful clinical activity in patients with metastatic pancreatic cancer.

Areas covered: In this review we have aimed to give an overview on the treatment options for patients diagnosed with metastatic pancreatic cancer with an emphasis on the safety and toxicity of the applied regimens. We have conducted a pubmed search using the terms ‘metastatic pancreatic cancer’, ‘palliative chemotherapy’, ‘safety’ and ‘toxicity’. Our special focus rested on randomized phase III trials to provide readers with the highest level of available evidence.

Expert opinion: The emergence of new and more effective chemotherapy regimens gives clinicians more freedom in the treatment of metastatic pancreatic cancer. While being more effective, these regiments have a considerable degree of toxicity. Choosing the right treatment for any individual will be the next major challenge treating patients with pancreatic cancer.

KEYWORDS:

• Gemcitabine
• nab-paclitaxel
• FOLFIRINOX
• palliative chemotherapy
• pancreatic cancer
• safety

Article highlights

• FOLFIRINOX as well as gemcitabine / nab-paclitaxel are two new active first-line regimens in the treatment of advanced pancreatic cancer.

• Careful treatment selection, e.g. based on performance status, co-morbidities and liver function tests, is mandatory for a safe use of FOLFIRINOX or gemcitabine / nab-paclitaxel.

• Optimal supportive care (e.g. antiemetics, growth factor support) and treatment surveillance may lead to a better tolerability of intensive combination chemotherapy in pancreatic adenocarcioma.

• Novel second-line treatment options after failure of first-line gemcitabine include 5-FU/FA in combination with either oxaliplatin or nanoliposomal-irinotecan (nal-Iri).

• Further research is necessary in order to define clinically relevant prognostic and predictive biomarkers for treatment efficacy and safety.

This box summarizes key points contained in the article.

Declaration of interests

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.