Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer
death in men and women in the United States. Despite significant improvements in mortality rate
in other types of GI cancers, there has been no improvement in PDAC mortality rates. The major
reason that PDAC has such a high mortality rate is the lack of early detection methods, and thus
the disease is diagnosed at late stages. This systematic review aims to outline current treatment
modalities available to give these patients the best chance at survival.
Objective: The purpose of the study is to review currently available first line and second line
treatment options for PDAC, as well as current research into additional treatment modalities in
order to alleviate the significant morbidity and mortality associated with this disease.
Methods: Studies were included if they 1) were included in a peer reviewed journal, 2)
specifically discussed PDAC, 3) analyzed and evaluated the effectiveness of current therapeutic
approaches, and 4) assessed current research into treatment modalities for PDAC. A
computerized search of 3 databases of scientific abstracts (e.g., PUBMED, MEDLINE, Embase)
were analyzed in a systematic fashion to review current first line and second line treatment in
order to assess their effectiveness. Using the Boolean/phrase “pancreatic adenocarcinoma
treatment” AND “surgery” OR “medication” OR “emergent treatment” OR “immunotherapy”
AND “efficacy,” 302 articles were identified with limits for English language, human studies,
adult cohort, and published within 4 years. We extracted data from only those studies on PDAC
treatment options that met our inclusion criteria; 17 studies retained for the final review.
Results: The study participants evaluated were newly diagnosed cases of PDAC (n = 2), patients
without prior treatment (n = 4), those with prior treatment (n = 9), or those with concurrent
standard therapy (n = 2). Of the studies involved, eight were clinical trials, five were
experimental studies, one was an observational review, and three were retrospective studies. The
first line treatments approved for PDAC are Folfirinox or Gemcitabine, with currently no
standard for second line options. Other options currently being pursued as future therapeutics
include immunotherapies, new robotic surgical options, and novel radiation regiments.
Conclusion: PDAC is well known for its high mortality rate due to many complications, but
most importantly due to lack of early detection and diagnosis. There is a significant amount of
research on current drug regimens, surgical treatments, and risk factors related to PDAC, but
there is a huge gap in research when it comes to pancreatic cancer screening options. This review
indicated that Folfirinox or Gemcitabine are the front runners for first line treatment options, but
there are many emerging treatment options in immunotherapy, electrochemotherapy, next
generation sequencing, and microbiome diversity.
