Second-line chemotherapy for advanced pancreatic cancer: Which is the best option?

Publication date: Available online 20 April 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Giuseppe Aprile, Francesca V. Negri, Francesco Giuliani, Elisa De Carlo, Davide Melisi, Francesca Simionato, Nicola Silvestris, Oronzo Brunetti, Francesco Leone, Donatella Marino, Daniele Santini, Emanuela Dell'Aquila, Tea Zeppola, Marco Puzzoni, Mario Scartozzi
Despite recent biological insight and therapeutic advances, the prognosis of advanced pancreatic cancer still remains poor. For more than 15 years, gemcitabine monotherapy has been the cornerstone of first-line treatment. Recently, prospective randomized trials have shown that novel upfront combination regimens tested in prospective randomized trials have resulted in improved patients' outcome increasing the proportion of putative candidate to second-line therapy. There is no definite standard of care after disease progression. A novel formulation in which irinotecan is encapsulated into liposomal-based nanoparticles may increase the efficacy of the drug without incrementing its toxicity. NAPOLI-1 was the first randomized trial to compare nanoliposomal irinotecan and fluorouracil-leucovorin (5-FU/LV) to 5-FU/LV alone after a gemcitabine-based chemotherapy. This review focuses on the current data for the management of second-line treatment for metastatic pancreatic adenocarcinoma, presents the most interesting ongoing clinical trials and illustrates the biologically-driven future options beyond disease progression.



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