Updates on First-Line Therapy for Metastatic Pancreatic Adenocarcinoma

  • Eric Marks Penn State Hershey Medical Center, Cancer Institute. Hershey, PA, USA
  • Muhammad Wasif Saif Hematology and Oncology, Tufts University School of Medicine. Boston, MA, USA
  • Yuxia Jia Penn State Hershey Medical Center, Cancer Institute. Hershey, PA, USA
Keywords: Adenocarcinoma, Drug Therapy, Immunotherapy, Neoplasm Metastasis, Pancreatic Neoplasms


Pancreatic adenocarcinoma is the 10th most common malignancy in the United States but is responsible for the 4th most cancer related deaths. This disease can only be potentially cured through early discovery and complete surgical resection. Unfortunately, nearly half of patients have metastatic spread at presentation. Combination chemotherapy with FOLFIRINOX or gemcitabine with nab-paclitaxel can prolong survival in selected patients, but at the cost of significant toxicity. In the 2014 ASCO Gastrointestinal Cancers Symposium, several studies were presented that focus on the management of metastatic pancreatic cancer. A phase II trial by Le et al. (Abstract #177) found that the addition of CRS-207, a strain of Listeria modified to stimulate an anti-tumor immune response, improves survival in patients being treated with GVAX. Goldstein et al. (Abstract #178) presented a post-hoc survival analysis for the phase III MPACT trial that shows the addition of nab-paclitaxel to gemcitabine produces a persistent survival benefit. Ramanathan et al. (Abstract #224) demonstrated that, with appropriate dose adjustments and delays, induction nab-paclitaxel and gemcitabine followed by mFOLFIRINOX consolidation is a feasible treatment option for metastatic pancreatic cancer. Despite these advances, it is imperative that we continue to work towards developing additional treatment options that are better tolerated and further prolong survival for these patients. This highlight article focuses on the first-line therapy of metastatic pancreatic adenocarcinoma.

Image: Penn State Hershey Medical Center. Hershey, PA, USA


Download data is not yet available.


Cancer Facts and Figures 2013. 2013, American Cancer Society: Atlanta.

SEER Cancer Statistics Review. Surveillance, Epidemiology, and End Results Program, 2013.

NCCN Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma, in www.nccn.org. 2014.

Ying JE, Zhu LM, Liu BX. Developments in metastatic pancreatic cancer: is gemcitabine still the standard? World J Gastroenterol, 2012. 18(8): p. 736-45. [PMID 22371633]

Nemunaitis J., Vaccines in cancer: GVAX, a GM-CSF gene vaccine. Expert Rev Vaccines, 2005. 4(3): p. 259-74. [PMID 16026242]

Le DT, Wang-Gillam A, Picozzi V, Greten TF, Crocenzi TS, Springett GM, et al., A phase 2, randomized trial of GVAX pancreas and CRS-207 immunotherapy versus GVAX along in patients with metastatic pancreatic adenocarcinoma: Updated results. J Clin Oncol 2014; 32(Suppl 3): Abstract 177.

Goldstein D, El Maraghi RH, Hammel P, Heinemann V, Kunzmann V, Sastre J, et al., Updated survival from a randomized phase III trial (MPACT) of nab-paclitaxel plus gemcitabine versus gemcitabine alone for patients with metastatic adenocarcinoma of the pancreas. J Clin Oncol 2014; 32(Suppl 3): Abstract 178.

Ramanathan R, Lee P, Seng J, Anthony SP, Rosen PJ, Mena RR, et al., Phase II study of induction therapy with gemcitabine and nab-paclitaxel followed by consolidation with mFOLFIRINOX in patients with metastatic pancreatic cancer. J Clin Oncol 2014; 32(Suppl 3): Abstract 224.

Neuzillet C, Tijeras-Raballand A, Cros J, Faivre S, Hammel P, Raymond E. Stromal expression of SPARC in pancreatic adenocarcinoma. Cancer Metastasis Rev. 2013 Dec;32(3-4):585-602.

Penn State Hershey Medical Center. Hershey, PA, USA
How to Cite
MarksE., SaifM., & JiaY. (2014). Updates on First-Line Therapy for Metastatic Pancreatic Adenocarcinoma. JOP. Journal of the Pancreas, 15(2), 99-102. https://doi.org/10.6092/1590-8577/2279
Highlights from the “2014 ASCO Gastrointestinal Cancers Symposium”. San Francisco, CA, USA. January 16-18, 2014

Most read articles by the same author(s)