Pancreatic cancer: from state-of-the-art treatments to promising novel therapies

Patient survival after resection of pancreatic ductal adenocarcinoma (PDAC) remains poor and more-effective adjuvant treatments are desperately needed; new strategies under investigation include targeting the tumour stroma and cancer stem cell compartmentNeoadjuvant therapy might improve the delivery of chemotherapy and radiation, and can enable early treatment of metastatic PDACThe role of chemoradiotherapy in the treatment of locally advanced PDAC is highly controversial; SMAD4 (DPC4) might represent a biomarker that identifies a subset of patients who could benefit from radiation added to systemic chemotherapyModest success has been achieved with FOLFIRINOX, and with novel cytotoxic agents (nab-paclitaxel and MM-398, for example) in the metastatic settingImmunotherapy (with the GVAX vaccine) has produced promising results in highly selected patientsPreclinical data suggest that therapies that remodel the stroma or increase programmed cell death protein 1 (PD-1) or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) expression might unveil activity of immune-checkpoint inhibitors