Clinical Oncology

[Reshaping preoperative treatment of pancreatic cancer in the era of precision medicine]

CASOLINO R1,2, BRACONI C1, MALLEO G3, PAIELLA S3, BASSI G3, MILELLA M4, DREYER S B1,5, FROELING FE M6, CHANG D K1,5, BIANKIN A V1,5,7, GOLAN T8

JUNE 30, 2021

Clinical Oncology - 2021;8(2)

[Summary – This review summarises the recent evidence on preoperative therapeutic strategies in pancreatic cancer and discusses the rationale for an imminent need for a personalised therapeutic approach in non-metastatic disease. The molecular diversity of pancreatic cancer and its influence on prognosis and treatment response, combined with the failure of ‘all-comer’ treatments to significantly impact on patient outcomes, requires a paradigm shift towards a genomic-driven approach. This is particularly important in the preoperative, potentially curable setting, where a personalised treatment allocation has the substantial potential to reduce pancreatic cancer mortality.]

AFFILIATIONS

  1. Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, Scotland, UK
  2. Departments of Medicine
  3. Departments of Surgery
  4. Departments of Medicine, Medical Oncology, University and Hospital Trust of Verona, Verona (VR), Italy
  5. West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow
  6. Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
  7. South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool, NSW, Australia
  8. Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[Relevance of adrenal insufficiency in the management of oncological patients]

IGAZ Péter

[Adrenal insufficiency has a complex relevance in oncology. On one hand, malignant tumors warranting treatment might develop in patients suffering from adrenal insufficiency, on the other hand, adrenal insufficiency might appear due to the progression of malignant tumor or to its therapy. During the progression of oncological disease, bilateral adrenal or very rarely pituitary metastases could result in adrenal insufficiency. Novel immune-checkpoint inhibitors, opioids and long-term glucocorticoid treatment can all lead to adrenal insufficiency. It is very important to recognize and to know the treatment of adrenal insufficiency, as failure of treating adrenal insufficiency might be related to severe, even fatal consequences. In this review, these clinically relevant fields are presented.]

Clinical Oncology

[The role of next-generation sequencing in clinival oncology]

KOTMAYER Lili, BÖDÖR Csaba

[Over the past decade next-generation sequencing has led to the in-depth understanding of the molecular background and driving mechanisms in most types of cancer. Parallel to the technological advances, novel targeted therapies have become available for oncology patients. As a result of this process, molecular diagnostics is now one of the main cornerstones of precision medicine with predictive biomarkers aiding patient care in oncology. In addition to standard monogenic testings, recently multigene testing methods based on next-generation sequencing came into view, supporting targeted therapeutic decisions and personalized medicine. In this review, we aim to depict the most important professional aspects related to the reasonable application of next-generation sequencing and the interpretation of its results.]

Clinical Oncology

[Combining angiogenesis- and checkpoint-inhibitors to potentiate each other’s effects]

PIKÓ Béla, BASSAM Ali, MARIK László

[Both, the inhibition of angiogenesis and the influence of immune-mediated processes play significantly growing role in non-surgical treatment of tumors. Neoangiogenesis of neoplasmas adversely affects the function of the immune system, so its inhibition enhances the action of T-lymphocytes and other factors that support their function, favorably affects the microenvironment of the tumor, while treatment with immune signaling sites helps to normalize the vascular system. Influencing those two targeting points together may have a beneficial effect. Authors present that the combined use of agents having those two targets in renal cell carcinoma, melanoma malignum, non-small cell lung cancer, colorectal cancer, hepatocellular and breast cancer noting that successful phase III studies have been performed predominantly in clear cell (or tumor that also contains a clear cell component) carcinomas. The authors emphasize that immunotherapy usually requires the detection of susceptibility-predicting parameters (corresponding PD-L1, MSI-H, dMMR, TMB-H) and that registered indications should be considered in addition to the therapeutic philosophy of tumor agnostic treatment.]

Clinical Oncology

[Microsatellites act as „seismographs” of the genome]

SÜKÖSD Farkas

[Short non-protein-coding repetitive regions consisting of 1-6 bp sequences are called microsatellites. Failure in DNA polymerase activity during replication may lead to an increase or reduction in the number of these repeats. Generally, these microsatellite number variations are corrected via the DNA repair machinery; if not, the alterations are transmitted to the progeny, which is also indicated by the elevated mutation rate in the offspring. Microsatellite instability (MSI) can also cause reading-frame problems, and this can lead to elevated expression of foreign antigens in tumors, promising an enhanced efficacy of the anti-tumour immune response. Thus, MSI indicates not only genetic instability but also an increased efficacy of immune checkpoint inhibitors. Various tools such as PCR-based techniques or immunohistochemical methods have been developed to confirm MSI and to examine the functionality of the DNA repair mechanisms in these patients. Additionally, the recent technology also allows us to examine of microsatellites by using next-generation sequencing or artificial intelligence-based image analysis methods. In this review, we summarize recent methodologies and the clinical significance of MSI analysis. ]

Clinical Oncology

[EMDR therapy in the treatment of oncology patients]

HAVELKA Judit

[The diagnosis and treatment of a life-threatening disease such as cancer involves exposure to psychological and physical stress and may constitute a traumatic experience for most people. Abnormal adaptation of neurobiological systems to the stress following experienced trauma, furthermore, individual fac­tors such as previous traumas may also play a role in PTSD development. In the context of oncology, there is a specific need to develop better tools for psychological assessment, that address cancer-related stressors. It is hypothesized that eye movement desensitization and reprocessing (EMDR) therapy promotes the elicitation of the innate self-healing capacity, the natural healing process of the immune system and adaptive information reprocessing. The EMDR therapeutic intervention with oncological patients aims to repair the psychic balance, empower resilience factors and to allow the processing of traumatic disease-related experiences.]

All articles in the issue

Related contents

Clinical Oncology

[Neoadjuvant treatment of rectal cancer]

PINTÉR Tamás

[Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery - total mesorectal excision (TMA) - are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fl uoropyrimidines (infusional 5-fl uorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so - based on positive results in colon cancer - adjuvant FOLFOX chemotherapy may be recommended.]

Hungarian Radiology

[Radiological diagnostics of the pancreas neoplasms - Onco Update 2005]

FORRAI Gábor, BODOKY György

[Authors reviewed the recent results of pancreas tumour radiological diagnostics and the place of the imaging and interventional methods. Systematical review of the most recent articles were summarized (July 2003-December 2004) in the following subjects: the etiology and clinico-pathology, general diagnostic and therapeutical questions of early pancreatic neoplasms, abdominal ultrasound, computed tomography, multidetector computed tomography, magnetic resonance imaging, MR-cholangiopancreatography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, intraductal ultrasound, endoscopic ultrasound-guided cytology, percutaneous biopsy, positron emission tomography, positron emission tomography - computed tomography, special pancreatic tumours. Experiences about the pancreas diagnostic methods are accumulating year-to-year rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering in the daily practice. These are the reasons why the up-to-date knowledge of the literature is mandatory.]

Lege Artis Medicinae

[Measurement of therapeutic response during the primary systemic therapy of breast cancer]

TŐKÉS Tímea, SZENTMÁRTONI Gyöngyvér, LENGYEL Zsolt, GYÖRKE Tamás, DANK Magdolna

[Primary systemic therapy (PST), also called as neoadjuvant therapy has a substantial role in the treatment of patients with breast cancer. There is an increasing need among clinicians for the monitoring of therapeutic effectiveness. Beyond simple physical examination, diagnostic imaging tools have the most important role in the measurement of the therapeutic response. Selecting the appropriate imaging method is crucial for the correct evaluation of the therapeutic response and for planning further therapy. In this paper we review breast imaging modalities currently available in Hungary and detail the efficiency of these modalities in the evaluation of the therapeutic response.]

Lege Artis Medicinae

[THE DIFFERENTIATION OF CHRONIC PANCREATITIS FROM PANCREATIC CANCER]

CZAKÓ László

[The poor prognosis of pancreatic cancer is mainly due to late diagnosis. The differentiation between pancreatic cancer and chronic pancreatitis is difficult, because the two diseases cause similar clinical symptoms and morphological alterations. Furthermore, chronic pancreatitis is associated with an increased risk of malignant transformation, thus the two diseases may be present simultaneously. The recent developments in molecular genetic tests and in imaging techniques, such as multidetector computed tomography, magnetic resonance cholangio- pancreatography, endoscopic ultrasoundguided fine needle aspiration and positron emission tomography/computed tomography, have fundamentally transformed the differentiation of the two disorders. This paper provides a systematic review of the recent evidence-based results concerning the differentiation of pancreatic cancer and chronic pancreatitis.]

Lege Artis Medicinae

[World Pancreatic Day - Constant vigilance!]

ILLÉS Dóra, CZAKÓ László

[Pancreatic cancer (PaC) is a rare disease. However, it has one of the highest mortality worldwide. In Hungary both the incidence and mortality are among the highest in Europe. Surgery is the only curative method to treat PaC. Unfortunately, PaC is often diagnosed in its inoperative stage due to the asymptomatic/aspecific progression. Unfortunately, there is no effective screening method for PaC. This article aims to raise awareness of PaC risks and symp­tomps upon the World Pancreatic Cancer Day (21.11) which indicate investigations to diagnose PaC in an early stage, in favor of a better outcome of the disease. ]