Pub Date : 2019-03-01Epub Date: 2019-03-11DOI: 10.21037/apc.2019.02.01
Noah S Rozich, Caitlin E Jones, Katherine T Morris
The objective of this article is to review the available literature examining the impact of malnutrition, frailty, and sarcopenia on surgical morbidity among pancreatic cancer patients. We examine definitions used to diagnose and quantify these conditions and review the differences between them with regards to preoperative assessment and postoperative outcomes. The most relevant scoring systems are summarized. Lastly, we summarize current knowledge regarding effectiveness of specific interventions aimed at malnutrition, frailty, and sarcopenia for patients undergoing pancreatic cancer surgery.
{"title":"Malnutrition, frailty, and sarcopenia in pancreatic cancer patients: assessments and interventions for the pancreatic surgeon.","authors":"Noah S Rozich, Caitlin E Jones, Katherine T Morris","doi":"10.21037/apc.2019.02.01","DOIUrl":"https://doi.org/10.21037/apc.2019.02.01","url":null,"abstract":"<p><p>The objective of this article is to review the available literature examining the impact of malnutrition, frailty, and sarcopenia on surgical morbidity among pancreatic cancer patients. We examine definitions used to diagnose and quantify these conditions and review the differences between them with regards to preoperative assessment and postoperative outcomes. The most relevant scoring systems are summarized. Lastly, we summarize current knowledge regarding effectiveness of specific interventions aimed at malnutrition, frailty, and sarcopenia for patients undergoing pancreatic cancer surgery.</p>","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/apc.2019.02.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25345116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastrointestinal (GI) cancer refers to the group of cancers that affect the digestive system. This includes cancers of the oesophagus, stomach, liver, pancreas, gallbladder and biliary tract, small intestine, colon, rectum and anus. GI cancers are regarded as a highly virulent neoplasm with both high morbidity and mortality. Collectively, they are a major cause of morbidity and mortality worldwide (1). Over the past half century, modern radiation therapy has been established and slowly evolved to treat different kinds of GI cancers. However, challenges remain in giving accurate and safe radiation delivery.
{"title":"Eugene J. Koay: translating promising new radiation technologies to patients with gastrointestinal cancers","authors":"Brad Li","doi":"10.21037/apc.2018.12.01","DOIUrl":"https://doi.org/10.21037/apc.2018.12.01","url":null,"abstract":"Gastrointestinal (GI) cancer refers to the group of cancers that affect the digestive system. This includes cancers of the oesophagus, stomach, liver, pancreas, gallbladder and biliary tract, small intestine, colon, rectum and anus. GI cancers are regarded as a highly virulent neoplasm with both high morbidity and mortality. Collectively, they are a major cause of morbidity and mortality worldwide (1). Over the past half century, modern radiation therapy has been established and slowly evolved to treat different kinds of GI cancers. However, challenges remain in giving accurate and safe radiation delivery.","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79022932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01Epub Date: 2019-01-16DOI: 10.21037/apc.2018.12.02
Patrick W Underwood, Michael H Gerber, Steven J Hughes
Minimally invasive approaches to abdominal surgical procedures have provided superior outcomes when compared to the open approach and thus have become the standard of care. However, minimally invasive pancreatoduodenectomy (MIPD) presents unique difficulties for both laparoscopic and robotic platforms and remains controversial. Ongoing concerns continue about the minimally invasive approach creating meaningful benefit when system-wide data may suggest MIPD results in increased morbidity and mortality during the learning curve. This treatise explores the current state of MIPD, reviewing the volume and quality of data that supports benefit while contrasting the benefits to the unique challenges associated with MIPD that may lead to unacceptable rates of complications and death. We conclude that in a handful of centers, MIPD confers an iterative but not transformative benefit. Significant barriers to the wide-spread acceptance of MIPD are apparent and persist, including: lack of high level data confirming clinical benefit, well defined patient selection criteria, formal education programs that address challenges of the learning curve, and ultimately value.
{"title":"Pitfalls of minimally invasive pancreatoduodenectomy.","authors":"Patrick W Underwood, Michael H Gerber, Steven J Hughes","doi":"10.21037/apc.2018.12.02","DOIUrl":"https://doi.org/10.21037/apc.2018.12.02","url":null,"abstract":"<p><p>Minimally invasive approaches to abdominal surgical procedures have provided superior outcomes when compared to the open approach and thus have become the standard of care. However, minimally invasive pancreatoduodenectomy (MIPD) presents unique difficulties for both laparoscopic and robotic platforms and remains controversial. Ongoing concerns continue about the minimally invasive approach creating meaningful benefit when system-wide data may suggest MIPD results in increased morbidity and mortality during the learning curve. This treatise explores the current state of MIPD, reviewing the volume and quality of data that supports benefit while contrasting the benefits to the unique challenges associated with MIPD that may lead to unacceptable rates of complications and death. We conclude that in a handful of centers, MIPD confers an iterative but not transformative benefit. Significant barriers to the wide-spread acceptance of MIPD are apparent and persist, including: lack of high level data confirming clinical benefit, well defined patient selection criteria, formal education programs that address challenges of the learning curve, and ultimately value.</p>","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/apc.2018.12.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37641522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-12-06DOI: 10.21037/apc.2018.11.01
Lei Zheng
Pancreatic cancer is resistant to the immunotherapy. This resistance is caused by any of the four immune "defects" that occur in pancreatic cancer, including lack of "high quality" T cells, stromal barriers to T cells getting access to tumor cells, immunosuppressive cells such as M2 macrophages, myeloid derivative suppressor cells, and T regulatory cells, in the tumor microenvironment of pancreatic cancer. One or more defects may occur in an individual pancreatic cancer. To overcome the resistance to the immunotherapy such as immune checkpoint inhibitors, a rational combination of agents that target multiple immune defects is highly demanded.
{"title":"Immune defects in pancreatic cancer.","authors":"Lei Zheng","doi":"10.21037/apc.2018.11.01","DOIUrl":"https://doi.org/10.21037/apc.2018.11.01","url":null,"abstract":"Pancreatic cancer is resistant to the immunotherapy. This resistance is caused by any of the four immune \"defects\" that occur in pancreatic cancer, including lack of \"high quality\" T cells, stromal barriers to T cells getting access to tumor cells, immunosuppressive cells such as M2 macrophages, myeloid derivative suppressor cells, and T regulatory cells, in the tumor microenvironment of pancreatic cancer. One or more defects may occur in an individual pancreatic cancer. To overcome the resistance to the immunotherapy such as immune checkpoint inhibitors, a rational combination of agents that target multiple immune defects is highly demanded.","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"1 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/apc.2018.11.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36838418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are over 20 different types of cystic lesions of the pancreas, most of which are benign (1). The four most common pancreatic cysts with neoplastic potential are serous cystadenoma (SCA), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN).
{"title":"Pancreatic cystic neoplasms: usually incidental, rarely incident","authors":"E. Duell","doi":"10.21037/APC.2018.09.04","DOIUrl":"https://doi.org/10.21037/APC.2018.09.04","url":null,"abstract":"There are over 20 different types of cystic lesions of the pancreas, most of which are benign (1). The four most common pancreatic cysts with neoplastic potential are serous cystadenoma (SCA), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN).","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88507346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Si, T. Hieken, A. Degnim, Zhiying Yang, H. Tan, Yongliang Sun, Liguo Liu, Wenying Zhou, Jia Huang
Background: The FOLFIRINOX regimen recently became the new standard of care for patients with advanced pancreatic cancer. However, FOLFIRINOX hasn’t been widely used in China as the hesitance of oncologists to use FOLFIRINOX due to the toxicity of the regimen and the presumption that Chinese patients could not tolerate FOLFIRINOX. Methods: We retrospectively analyzed the clinical data of ten patients with pancreatic cancer who received the FOLFIRINOX regimen from July 2016 to July 2018. The two woman and eight men enrolled were aged 29 to 76 years. Three, three, and four patients were diagnosed with borderline resectable pancreatic cancer (BRPC), liver-metastatic pancreatic cancer (LMPC), and recurrent pancreatic cancer (RPC), respectively. Seven and three patients received a full or 80% initial dose, according to their Eastern Cooperative Oncology Group performance status. Results: One of the seven patients was administered an 80% dose after the second cycle because of febrile neutropenia (grade >3). The most common adverse event was neutropenia (grade 2). Four patients with BRPC or LMPC successfully underwent surgical resection. Two patients with LMPC achieved partial remission (PR). The levels of the serum carbohydrate antigen 19-9 of three patients with RPC significantly decreased (>60%). Conclusions: The FOLFIRINOX regimen is effective and is tolerated by certain Chinese patients with advanced pancreatic cancer. The dose of the FOLFIRINOX regimen should be individually adjusted to reduce toxicity.
{"title":"Case analysis of pancreatic cancer treated with FOLFIRINOX in China","authors":"S. Si, T. Hieken, A. Degnim, Zhiying Yang, H. Tan, Yongliang Sun, Liguo Liu, Wenying Zhou, Jia Huang","doi":"10.21037/APC.2018.09.01","DOIUrl":"https://doi.org/10.21037/APC.2018.09.01","url":null,"abstract":"Background: The FOLFIRINOX regimen recently became the new standard of care for patients with advanced pancreatic cancer. However, FOLFIRINOX hasn’t been widely used in China as the hesitance of oncologists to use FOLFIRINOX due to the toxicity of the regimen and the presumption that Chinese patients could not tolerate FOLFIRINOX. \u0000 Methods: We retrospectively analyzed the clinical data of ten patients with pancreatic cancer who received the FOLFIRINOX regimen from July 2016 to July 2018. The two woman and eight men enrolled were aged 29 to 76 years. Three, three, and four patients were diagnosed with borderline resectable pancreatic cancer (BRPC), liver-metastatic pancreatic cancer (LMPC), and recurrent pancreatic cancer (RPC), respectively. Seven and three patients received a full or 80% initial dose, according to their Eastern Cooperative Oncology Group performance status. \u0000 Results: One of the seven patients was administered an 80% dose after the second cycle because of febrile neutropenia (grade >3). The most common adverse event was neutropenia (grade 2). Four patients with BRPC or LMPC successfully underwent surgical resection. Two patients with LMPC achieved partial remission (PR). The levels of the serum carbohydrate antigen 19-9 of three patients with RPC significantly decreased (>60%). \u0000 Conclusions: The FOLFIRINOX regimen is effective and is tolerated by certain Chinese patients with advanced pancreatic cancer. The dose of the FOLFIRINOX regimen should be individually adjusted to reduce toxicity.","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"2181 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91387022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01Epub Date: 2018-10-10DOI: 10.21037/apc.2018.09.03
Gregory B Lesinski
{"title":"Stressing for sugar: a new role of serotonin for glycolysis in pancreatic cancer cells.","authors":"Gregory B Lesinski","doi":"10.21037/apc.2018.09.03","DOIUrl":"https://doi.org/10.21037/apc.2018.09.03","url":null,"abstract":"","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"1 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/apc.2018.09.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38047564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
New literature published in Gut has shown that combined treatment of anti-BAG3 mAb and anti-PD-1 mAb in pancreatic cancer can eliminate tumor-associated macrophages (TAMs), increase tumor infiltrating CD8+ T cells and result in tumor growth suppression (1). These findings highlight the potential of BAG3 (Bcl-2-associated athanogene 3) as a therapeutic target in conjunction with immune checkpoint blockade in the treatment of pancreatic cancer.
{"title":"Depletion of tumor associated macrophages by anti-BAG3 treatment complements PD-1 blockade in pancreatic cancer","authors":"Yi Sun, R. Torphy, Yuwen Zhu","doi":"10.21037/APC.2018.10.01","DOIUrl":"https://doi.org/10.21037/APC.2018.10.01","url":null,"abstract":"New literature published in Gut has shown that combined treatment of anti-BAG3 mAb and anti-PD-1 mAb in pancreatic cancer can eliminate tumor-associated macrophages (TAMs), increase tumor infiltrating CD8+ T cells and result in tumor growth suppression (1). These findings highlight the potential of BAG3 (Bcl-2-associated athanogene 3) as a therapeutic target in conjunction with immune checkpoint blockade in the treatment of pancreatic cancer.","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81726680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pancreatic ductal adenocarcinoma (PDAC) is a debilitating disease that continues to have rising incidence and mortality rates. In 2018, it is estimated that nearly 56,000 individuals will be newly diagnosed with pancreatic cancer (1). Surgical resection remains the only possible curative measure as pancreatic cancer is notoriously resistant to systemic chemotherapy, has high rates of recurrence, and is associated with a 5-year survival rate of 8.5 (1).
{"title":"Uncovering the role of immunosuppressive dendritic cells in pancreatic cancer","authors":"D. Thomas, A. Murphy","doi":"10.21037/APC.2018.09.02","DOIUrl":"https://doi.org/10.21037/APC.2018.09.02","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is a debilitating disease that continues to have rising incidence and mortality rates. In 2018, it is estimated that nearly 56,000 individuals will be newly diagnosed with pancreatic cancer (1). Surgical resection remains the only possible curative measure as pancreatic cancer is notoriously resistant to systemic chemotherapy, has high rates of recurrence, and is associated with a 5-year survival rate of 8.5 (1).","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73285417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-01Epub Date: 2018-08-06DOI: 10.21037/apc.2018.07.05
Nikhil Yegya-Raman, Mihir M Shah, Miral S Grandhi, Elizabeth Poplin, David A August, Timothy J Kennedy, Usha Malhotra, Kristen R Spencer, Darren R Carpizo, Salma K Jabbour
Of all patients diagnosed with pancreatic adenocarcinoma, only 15-20% present with resectable disease. Despite curative-intent resection, the prognosis remains poor with the majority of patients recurring, prompting the need for adjuvant therapy. Historical data support the use of adjuvant 5-fluorouracil (5-FU) or gemcitabine, but recent data suggest either gemcitabine plus capecitabine or modified FOLFIRINOX can improve overall survival when compared to gemcitabine alone. The use of adjuvant chemoradiation therapy remains controversial, primarily due to limitations in study design and mixed results of historical trials. The ongoing Radiation Therapy Oncology Group (RTOG)-0848 trial hopes to further define the role of adjuvant chemoradiation therapy. Intraoperative radiation therapy (IORT) and adjuvant immunotherapy represent additional possibilities to improve outcomes, but evidence supporting their use is limited. This article reviews adjuvant therapeutic strategies for resectable pancreatic adenocarcinoma, including chemotherapy, chemoradiation therapy, IORT and immunotherapy.
{"title":"Adjuvant therapeutic strategies for resectable pancreatic adenocarcinoma.","authors":"Nikhil Yegya-Raman, Mihir M Shah, Miral S Grandhi, Elizabeth Poplin, David A August, Timothy J Kennedy, Usha Malhotra, Kristen R Spencer, Darren R Carpizo, Salma K Jabbour","doi":"10.21037/apc.2018.07.05","DOIUrl":"https://doi.org/10.21037/apc.2018.07.05","url":null,"abstract":"<p><p>Of all patients diagnosed with pancreatic adenocarcinoma, only 15-20% present with resectable disease. Despite curative-intent resection, the prognosis remains poor with the majority of patients recurring, prompting the need for adjuvant therapy. Historical data support the use of adjuvant 5-fluorouracil (5-FU) or gemcitabine, but recent data suggest either gemcitabine plus capecitabine or modified FOLFIRINOX can improve overall survival when compared to gemcitabine alone. The use of adjuvant chemoradiation therapy remains controversial, primarily due to limitations in study design and mixed results of historical trials. The ongoing Radiation Therapy Oncology Group (RTOG)-0848 trial hopes to further define the role of adjuvant chemoradiation therapy. Intraoperative radiation therapy (IORT) and adjuvant immunotherapy represent additional possibilities to improve outcomes, but evidence supporting their use is limited. This article reviews adjuvant therapeutic strategies for resectable pancreatic adenocarcinoma, including chemotherapy, chemoradiation therapy, IORT and immunotherapy.</p>","PeriodicalId":8372,"journal":{"name":"Annals of Pancreatic Cancer","volume":"1 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/apc.2018.07.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36903219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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