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*Only for medical professionals to read for reference, where should the neoadjuvant and adjuvant treatment of pancreatic cancer go? Professor Yang Yinmo will give you a detailed explanation of the latest research progress.
Pancreatic cancer is the most malignant tumor of the digestive tract, with insidious onset and rapid progress.
In the past 50-60 years, although some progress has been made in the treatment of pancreatic cancer, the prognosis of patients has not been significantly improved.
In order to better optimize the diagnosis and treatment of pancreatic cancer, we searched for pancreatic cancer-related studies published in high-impact factor journals since 2021, and were fortunate to invite Professor Yang Yinmo from Peking University First Hospital to discuss the 2021 JAMA Oncology (impact factor: 24.
799) journal A published study on the perioperative treatment of pancreatic cancer provides an in-depth interpretation.
Click to watch the wonderful video of Professor Yang Yinmo.
Resectable pancreatic cancer: Neoadjuvant treatment is indispensable.
In recent years, pancreatic cancer surgical techniques have made great progress.
The mature development and application of laparoscopic, robotic, and minimally invasive techniques in pancreatic cancer surgery have made the pancreas The perioperative mortality and complication rate of cancer patients have been greatly reduced, and the safety of surgery has been significantly improved.
However, advances in surgical technology have not significantly improved the long-term prognosis of patients with pancreatic cancer.
According to Cancer Statistics 2021 data, the 5-year survival rate of pancreatic cancer is only 10%, which is the lowest among all malignant tumors [1].
Whether it is surgical treatment or comprehensive treatment, pancreatic cancer still faces great challenges in all aspects.
Figure 1.
The 5-year survival rate of pancreatic cancer (based on race and stage).
As the treatment model of pancreatic cancer has changed from "surgery first" to multidisciplinary comprehensive treatment in the past, comprehensive perioperative treatment has also received increasing attention.
For neoadjuvant therapy, current domestic and foreign guidelines and consensus clearly recommend that borderline resectable pancreatic cancer should be treated with neoadjuvant therapy before surgery.
The consideration of neoadjuvant therapy for this type of patients is mainly based on the following two factors: 1.
Pancreatic cancer is a systemic disease, and surgical treatment is a local treatment.
Clinically, when the timing of surgery is selected, the patient may already have systemic micrometastases.
Neoadjuvant treatment can help eliminate micrometastases and reduce the patient's distant metastasis rate and recurrence rate after surgery.
2.
Neoadjuvant therapy helps to screen patients, observe tumor biological behavior, and provide a window period for clinical treatment.
If the tumor continues to progress during neoadjuvant treatment, it means that the tumor's biological behavior is poor.
Although surgical resection is technically possible, the poor biological behavior of the tumor is often difficult to achieve radical cure.
Neoadjuvant treatment can help increase the rate of local negative margins and further reduce the rate of local recurrence.
Resectable pancreatic cancer: the hope and confusion of neoadjuvant therapy There are still many controversies about whether patients with resectable pancreatic cancer also need neoadjuvant therapy, and there is no clear consensus.
At this stage, it is believed that patients with resectable pancreatic cancer with high risk factors for recurrence, such as high levels of the tumor marker CA19-9, high tumor burden or suspected regional lymph node metastasis, may benefit from neoadjuvant therapy.
For these patients, neoadjuvant therapy is recommended to reduce the rate of local recurrence and distant metastasis and improve the treatment effect.
Figure 2.
A study published by JAMA Oncology 2021 JAMA Oncology (impact factor: 24.
799) published a randomized phase II clinical study of perioperative chemotherapy [2], which explored the 2-year overall survival of resectable pancreatic cancer with perioperative chemotherapy rate.
A total of 147 patients were enrolled in the study, and they were randomly divided into one and two groups.
One group was given mFOLFIRINOX once every two weeks, a total of 6 courses of neoadjuvant therapy and 6 courses of adjuvant therapy; the 2 groups were treated with albumin and paclitaxel.
Once a week, lasting 3 weeks and 1 week off, a total of 9 courses of neoadjuvant therapy and 9 courses of adjuvant therapy.
The results showed that the completion rate of neoadjuvant treatment in group 1 was 84%, and that in group 2 was 85%; the surgical resection rates in the two groups were 73% and 70%, respectively.
Among patients undergoing surgical resection, 78% of patients in group 1 received adjuvant chemotherapy after surgery, with a completion rate of 68%; 79% of patients in group 2 received adjuvant chemotherapy after surgery, with a completion rate of 58%.
There was no statistically significant difference in the 2-year overall survival rate and median overall survival between the two groups of patients, which were 47% vs 48% and 23.
2 months vs 23.
6 months, respectively.
Figure 3.
Subject's overall survival.
This study shows that neoadjuvant therapy is safer for resectable pancreatic cancer and can increase the R0 resection rate.
However, the reason for the no significant difference in survival between the two groups of patients may be due to the small number of samples in the study, and the inclusion of both pancreatic head cancer and pancreatic body and tail cancer, which has certain limitations; on the other hand, it also It may be because the study's evaluation of the efficacy of resectable pancreatic cancer is still based on morphological evaluation, without introducing biological evaluation, such as CA19-9.
The heterogeneity among patients is large, and the unified treatment evaluation standard fails to reflect the treatment method.
The advantages.
Professor Yang Yinmo said that although the study did not achieve an improvement in survival, it still cannot completely deny the significance of neoadjuvant therapy for resectable pancreatic cancer, and high-quality research is still needed for further verification.
For resectable pancreatic cancer with a high risk of recurrence, neoadjuvant therapy is advocated, but there is still a lack of quantitative standards for high-risk risk factors.
For example, what is the appropriate setting for a high CA19-9 value,> 1000 u/ml or> 500 u/ml .
In the future, further clinical research is needed for the treatment of resectable pancreatic cancer.
Overall, the application of neoadjuvant therapy in pancreatic cancer is still very promising.
Future prospects of pancreatic cancer treatment Professor Yang Yinmo pointed out that it is difficult to fundamentally improve the prognosis of pancreatic cancer by the development of surgical technology alone.
It is also necessary to develop new chemotherapeutic drugs, targeted and immunotherapeutic drugs to improve the therapeutic effect of pancreatic cancer.
Because pancreatic cancer is a cold tumor and has primary drug resistance, it is particularly important to develop new chemotherapeutic drugs to improve the sensitivity of pancreatic cancer treatment.
If there is no breakthrough in drugs, just a combination of current drugs, it will be difficult to greatly improve the prognosis of patients.
In recent years, we have also made a lot of efforts in the advancement and optimization of chemotherapeutic drug formulations, technologies, such as irinotecan liposomes, albumin paclitaxel, etc.
through nanotechnology to improve drug penetration capabilities, not only to increase the local drug concentration, biological The utilization rate also reduces the toxic and side effects of the drug.
The latest "Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Pancreatic Cancer" also updated the irinotecan liposome + 5-fluorouracil (5-FU)/calcium folinate (LV) regimen to type 1A evidence, and increased to metastatic The I-level expert recommendation of the second-line treatment of pancreatic cancer [3] provides a new option for improving the prognosis of patients with pancreatic cancer.
Finally, Professor Yang Yinmo said that with the transformation and renewal of treatment concepts, the development of new drugs and the reference to other tumors in targeted therapy and immunotherapy, he believes that comprehensive treatment of pancreatic cancer will definitely improve the prognosis of pancreatic cancer patients in the future.
, And finally conquered this "king of cancer.
"
Expert profile Professor Yang Yinmo, chief surgeon, professor, and doctoral supervisor of Peking University First Hospital, member of the American College of Surgery (FACS), deputy head of the pancreatology group of the Chinese Medical Association Surgery Branch, member of the 18th Committee of the Chinese Medical Association Surgery Branch Zhonghua Member of the Eleventh Committee of the Oncology Branch of the Medical Association; Vice Chairman of the General Surgery Expert Committee of the Beijing Medical Association; Member of the Standing Committee of the Surgery Branch of the Beijing Medical Association; Member of the Standing Committee of the Oncology Branch of the Beijing Medical Association; Editor-in-chief, associate editor of "International Journal of Surgery", "Chinese Journal of Surgery", "Chinese Medical Journal", "Chinese Journal of Practical Surgery", "British Medical Journal Chinese Edition (BMJ)", Langenbeck Archives of Surgery and other journals.
Servier is the second largest pharmaceutical company in France and one of the top 30 pharmaceutical companies in the world.
Servier is completely managed by a non-profit foundation.
Globally, 94 million patients are treated with Servier's drugs every day.
Servier focuses on the development of the oncology field.
A quarter of its sales are used for research and development, and 37% of it is invested in oncology, hoping to benefit more cancer patients. There are currently 26 anti-tumor drugs under research, including immunotherapy, targeted therapy and chemotherapy drugs, covering solid tumors and hematological tumors.
Pancreatic cancer is the most malignant tumor of the digestive tract, with insidious onset and rapid progress.
In the past 50-60 years, although some progress has been made in the treatment of pancreatic cancer, the prognosis of patients has not been significantly improved.
In order to better optimize the diagnosis and treatment of pancreatic cancer, we searched for pancreatic cancer-related studies published in high-impact factor journals since 2021, and were fortunate to invite Professor Yang Yinmo from Peking University First Hospital to discuss the 2021 JAMA Oncology (impact factor: 24.
799) journal A published study on the perioperative treatment of pancreatic cancer provides an in-depth interpretation.
Click to watch the wonderful video of Professor Yang Yinmo.
Resectable pancreatic cancer: Neoadjuvant treatment is indispensable.
In recent years, pancreatic cancer surgical techniques have made great progress.
The mature development and application of laparoscopic, robotic, and minimally invasive techniques in pancreatic cancer surgery have made the pancreas The perioperative mortality and complication rate of cancer patients have been greatly reduced, and the safety of surgery has been significantly improved.
However, advances in surgical technology have not significantly improved the long-term prognosis of patients with pancreatic cancer.
According to Cancer Statistics 2021 data, the 5-year survival rate of pancreatic cancer is only 10%, which is the lowest among all malignant tumors [1].
Whether it is surgical treatment or comprehensive treatment, pancreatic cancer still faces great challenges in all aspects.
Figure 1.
The 5-year survival rate of pancreatic cancer (based on race and stage).
As the treatment model of pancreatic cancer has changed from "surgery first" to multidisciplinary comprehensive treatment in the past, comprehensive perioperative treatment has also received increasing attention.
For neoadjuvant therapy, current domestic and foreign guidelines and consensus clearly recommend that borderline resectable pancreatic cancer should be treated with neoadjuvant therapy before surgery.
The consideration of neoadjuvant therapy for this type of patients is mainly based on the following two factors: 1.
Pancreatic cancer is a systemic disease, and surgical treatment is a local treatment.
Clinically, when the timing of surgery is selected, the patient may already have systemic micrometastases.
Neoadjuvant treatment can help eliminate micrometastases and reduce the patient's distant metastasis rate and recurrence rate after surgery.
2.
Neoadjuvant therapy helps to screen patients, observe tumor biological behavior, and provide a window period for clinical treatment.
If the tumor continues to progress during neoadjuvant treatment, it means that the tumor's biological behavior is poor.
Although surgical resection is technically possible, the poor biological behavior of the tumor is often difficult to achieve radical cure.
Neoadjuvant treatment can help increase the rate of local negative margins and further reduce the rate of local recurrence.
Resectable pancreatic cancer: the hope and confusion of neoadjuvant therapy There are still many controversies about whether patients with resectable pancreatic cancer also need neoadjuvant therapy, and there is no clear consensus.
At this stage, it is believed that patients with resectable pancreatic cancer with high risk factors for recurrence, such as high levels of the tumor marker CA19-9, high tumor burden or suspected regional lymph node metastasis, may benefit from neoadjuvant therapy.
For these patients, neoadjuvant therapy is recommended to reduce the rate of local recurrence and distant metastasis and improve the treatment effect.
Figure 2.
A study published by JAMA Oncology 2021 JAMA Oncology (impact factor: 24.
799) published a randomized phase II clinical study of perioperative chemotherapy [2], which explored the 2-year overall survival of resectable pancreatic cancer with perioperative chemotherapy rate.
A total of 147 patients were enrolled in the study, and they were randomly divided into one and two groups.
One group was given mFOLFIRINOX once every two weeks, a total of 6 courses of neoadjuvant therapy and 6 courses of adjuvant therapy; the 2 groups were treated with albumin and paclitaxel.
Once a week, lasting 3 weeks and 1 week off, a total of 9 courses of neoadjuvant therapy and 9 courses of adjuvant therapy.
The results showed that the completion rate of neoadjuvant treatment in group 1 was 84%, and that in group 2 was 85%; the surgical resection rates in the two groups were 73% and 70%, respectively.
Among patients undergoing surgical resection, 78% of patients in group 1 received adjuvant chemotherapy after surgery, with a completion rate of 68%; 79% of patients in group 2 received adjuvant chemotherapy after surgery, with a completion rate of 58%.
There was no statistically significant difference in the 2-year overall survival rate and median overall survival between the two groups of patients, which were 47% vs 48% and 23.
2 months vs 23.
6 months, respectively.
Figure 3.
Subject's overall survival.
This study shows that neoadjuvant therapy is safer for resectable pancreatic cancer and can increase the R0 resection rate.
However, the reason for the no significant difference in survival between the two groups of patients may be due to the small number of samples in the study, and the inclusion of both pancreatic head cancer and pancreatic body and tail cancer, which has certain limitations; on the other hand, it also It may be because the study's evaluation of the efficacy of resectable pancreatic cancer is still based on morphological evaluation, without introducing biological evaluation, such as CA19-9.
The heterogeneity among patients is large, and the unified treatment evaluation standard fails to reflect the treatment method.
The advantages.
Professor Yang Yinmo said that although the study did not achieve an improvement in survival, it still cannot completely deny the significance of neoadjuvant therapy for resectable pancreatic cancer, and high-quality research is still needed for further verification.
For resectable pancreatic cancer with a high risk of recurrence, neoadjuvant therapy is advocated, but there is still a lack of quantitative standards for high-risk risk factors.
For example, what is the appropriate setting for a high CA19-9 value,> 1000 u/ml or> 500 u/ml .
In the future, further clinical research is needed for the treatment of resectable pancreatic cancer.
Overall, the application of neoadjuvant therapy in pancreatic cancer is still very promising.
Future prospects of pancreatic cancer treatment Professor Yang Yinmo pointed out that it is difficult to fundamentally improve the prognosis of pancreatic cancer by the development of surgical technology alone.
It is also necessary to develop new chemotherapeutic drugs, targeted and immunotherapeutic drugs to improve the therapeutic effect of pancreatic cancer.
Because pancreatic cancer is a cold tumor and has primary drug resistance, it is particularly important to develop new chemotherapeutic drugs to improve the sensitivity of pancreatic cancer treatment.
If there is no breakthrough in drugs, just a combination of current drugs, it will be difficult to greatly improve the prognosis of patients.
In recent years, we have also made a lot of efforts in the advancement and optimization of chemotherapeutic drug formulations, technologies, such as irinotecan liposomes, albumin paclitaxel, etc.
through nanotechnology to improve drug penetration capabilities, not only to increase the local drug concentration, biological The utilization rate also reduces the toxic and side effects of the drug.
The latest "Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Pancreatic Cancer" also updated the irinotecan liposome + 5-fluorouracil (5-FU)/calcium folinate (LV) regimen to type 1A evidence, and increased to metastatic The I-level expert recommendation of the second-line treatment of pancreatic cancer [3] provides a new option for improving the prognosis of patients with pancreatic cancer.
Finally, Professor Yang Yinmo said that with the transformation and renewal of treatment concepts, the development of new drugs and the reference to other tumors in targeted therapy and immunotherapy, he believes that comprehensive treatment of pancreatic cancer will definitely improve the prognosis of pancreatic cancer patients in the future.
, And finally conquered this "king of cancer.
"
Expert profile Professor Yang Yinmo, chief surgeon, professor, and doctoral supervisor of Peking University First Hospital, member of the American College of Surgery (FACS), deputy head of the pancreatology group of the Chinese Medical Association Surgery Branch, member of the 18th Committee of the Chinese Medical Association Surgery Branch Zhonghua Member of the Eleventh Committee of the Oncology Branch of the Medical Association; Vice Chairman of the General Surgery Expert Committee of the Beijing Medical Association; Member of the Standing Committee of the Surgery Branch of the Beijing Medical Association; Member of the Standing Committee of the Oncology Branch of the Beijing Medical Association; Editor-in-chief, associate editor of "International Journal of Surgery", "Chinese Journal of Surgery", "Chinese Medical Journal", "Chinese Journal of Practical Surgery", "British Medical Journal Chinese Edition (BMJ)", Langenbeck Archives of Surgery and other journals.
Servier is the second largest pharmaceutical company in France and one of the top 30 pharmaceutical companies in the world.
Servier is completely managed by a non-profit foundation.
Globally, 94 million patients are treated with Servier's drugs every day.
Servier focuses on the development of the oncology field.
A quarter of its sales are used for research and development, and 37% of it is invested in oncology, hoping to benefit more cancer patients. There are currently 26 anti-tumor drugs under research, including immunotherapy, targeted therapy and chemotherapy drugs, covering solid tumors and hematological tumors.
