Maintenance therapies in metastatic pancreatic cancer: present and future with a focus on PARP inhibitors

Therapeutic Advances in Medical Oncology
Pascal HammelCindy Neuzillet

Abstract

Metastatic pancreatic ductal adenocarcinomas (PDACs) are now more effectively controlled using chemotherapy combinations such as FOLFIRINOX and gemcitabine plus nab-paclitaxel (NabP) regimens with a subset of patients who achieve a sustained tumor stabilization or response. The next challenge is to design maintenance therapies that result in continued tumor control with minimal toxicity. Quality of life should always be a priority in these patients with prolonged survival. Gradually tapering off the intensity of chemotherapy by suppressing drug(s) in the combination is one option. Thus, maintenance with 5-fluorouracil or gemcitabine as single agents after FOLFIRINOX or gemcitabine-NabP induction, respectively, seems to be a promising approach to minimize neurotoxicity while maintaining efficacy. Another option is to introduce maintenance drug(s) with different anti-tumoral actions. The recent example of olaparib in patients with BRCA mutated PDAC provides a promising proof-of-concept of a switch maintenance strategy in this setting.

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Citations

Dec 4, 2020·International Journal of Molecular Sciences·Chiara BazzichettoMichele Milella
May 20, 2021·World Journal of Gastroenterology : WJG·Michael N RosenMichael M Vickers
Jun 7, 2021·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Flore PignonLouis de Mestier

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Methods Mentioned

BETA
surgical resection

Clinical Trials Mentioned

NCT02945267
NCT04228601
NCT03331562
NCT03140670
NCT03376659
NCT03806309

Software Mentioned

OPTINAB

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