Multimodality Treatment Approaches in Pancreatic Cancer: Current Status and Future Perspectives Multimodale Behandlungsansätze bei Pankreaskarzinom: Gegenwart und Zukunft

Summary: Background: Pancreatic cancer is characterized by early local and systemic spread and low complete resection rates. Patients are highly symptomatic and the sensitivity of the tumour cells towards irradiation and most of the currently available chemotherapeutic agents is low. These factors account for the dismal prognosis.Methods: A critical analysis of adjuvant and neoadjuvant treatment results for resectable pancreatic cancer is presented. Management issues for unresectable pancreatic cancer and novel therapeutic approaches are discussed.Results: Recently, a gradual improvement in results from surgery and in chemotherapeutic efficacy has been observed. The local disease extension and the rapid dissemination call for a multimodality treatment consisting of surgery, if possible, radiotherapy, and efficient systemic chemotherapy both in the (neo)adjuvant setting as well as in locally advanced unresectable tumours. In resectable cancers, neoadjuvant treatment seems preferable, but should be followed within clinical trials. Local chemotherapies or chemoimmunotherapies have provided promising results but must be considered experimental. New cytotoxic agents are used for improved radiosensitization and for better systemic disease control. Their optimal dosage, sequence, and combination with surgery and/or radiotherapy still have to be established.Conclusions: Improvement may be expected from a better understanding of tumour biology, the developing armoury of drugs targeting angiogenesis, oncogene signalling, and metastatic potential as well as from vaccination strategies incorporated into multimodality treatments. Finally, genetic analyses will allow better risk stratification and individualization of treatment options.