Pretta A, Spanu D, Mariani S, Liscia N, Ziranu P, Pusceddu V, Puzzoni M, Massa E, Scartozzi M, Lai E. How to improve metastatic pancreatic ductal adenocarcinoma patients’ selection: Between clinical trials and the real-world. World J Clin Oncol 2022; 13(5): 417-422 [PMID: 35662988 DOI: 10.5306/wjco.v13.i5.417]
Corresponding Author of This Article
Mario Scartozzi, MD, Chairman, Full Professor, Medical Oncology Unit, University Hospital and University of Cagliari, SS 554, bivio per Sestu, km 4,500, Monserrato 09042, Cagliari, Italy. marioscartozzi@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. May 24, 2022; 13(5): 417-422 Published online May 24, 2022. doi: 10.5306/wjco.v13.i5.417
How to improve metastatic pancreatic ductal adenocarcinoma patients’ selection: Between clinical trials and the real-world
Andrea Pretta, Dario Spanu, Stefano Mariani, Nicole Liscia, Pina Ziranu, Valeria Pusceddu, Marco Puzzoni, Elena Massa, Mario Scartozzi, Eleonora Lai
Andrea Pretta, Dario Spanu, Stefano Mariani, Pina Ziranu, Valeria Pusceddu, Marco Puzzoni, Elena Massa, Mario Scartozzi, Eleonora Lai, Medical Oncology Unit, University Hospital and University of Cagliari, Monserrato 09042, Cagliari, Italy
Nicole Liscia, Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milano 20121, Italy
Author contributions: All authors wrote and edited the manuscript.
Conflict-of-interest statement: Prof. Scartozzi reports associations with Amgen, Sanofi, MERCK SHARP DOHME, Eisai, Merck, and Bayer, outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mario Scartozzi, MD, Chairman, Full Professor, Medical Oncology Unit, University Hospital and University of Cagliari, SS 554, bivio per Sestu, km 4,500, Monserrato 09042, Cagliari, Italy. marioscartozzi@gmail.com
Received: January 5, 2022 Peer-review started: January 5, 2022 First decision: February 15, 2022 Revised: April 1, 2022 Accepted: May 5, 2022 Article in press: May 5, 2022 Published online: May 24, 2022 Processing time: 138 Days and 18.6 Hours
Abstract
As underlined in the minireview by Blomstrand et al, given the poor prognosis and the paucity of data on a therapeutic sequence in pancreatic ductal adenocarcinoma (PDAC), additional randomized controlled trials and real-world evidence studies addressing current and novel regimens are needed. The real-world outcomes of first-line chemotherapy regimens such as FOLFIRINOX and gemcitabine/nab-paclitaxel are thoroughly reviewed and seem to be largely generalizable in a real-world context. Regarding second-line chemotherapy, the key question about the optimal sequence of regimens remains uncertain. Precisely in this setting, it is therefore useful to encourage the implementation of clinical studies that may contribute to the scarcity of data available up to now. We report our experience with a small group of patients treated with second-line liposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin. To improve the treatment of patients affected by PDAC, it is useful to identify subgroups of patients who may benefit from target treatments (e.g., BRCA mutant) and it is also important to focus on any prognostic factors that may affect the survival and treatment of these patients.
Core Tip: The present letter is intended to contribute to the collection of data on pancreatic ductal adenocarcinoma (PDAC) treatments in second-line settings through our experience with the promising data of efficacy and safety of a small group of study patients treated with second-line liposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin. We also focused on highlighting the subgroups of PDAC patients who might benefit from target treatments, such as a small proportion of mutated BRCAs, and to identify comorbidities or characteristics that impact the prognosis of PDAC patients through our retrospective analysis that demonstrate a correlation between type II diabetes mellitus and improved overall survival.
