Abstract

Pancreatic adenocarcinoma is the 10th most common malignancy in the United States but is responsible for the 4th mostcancer 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 FOLFIRINOXor gemcitabine with nab-paclitaxel can prolong survival in selected patients, but at the cost of significant toxicity. In the 2014ASCO Gastrointestinal Cancers Symposium, several studies were presented that focus on the management of metastaticpancreatic cancer. A phase II trial by Le et al. (Abstract #177) found that the addition of CRS-207, a strain of Listeria modifiedto 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-paclitaxelto gemcitabine produces a persistent survival benefit. Ramanathan et al. (Abstract #224) demonstrated that, withappropriate dose adjustments and delays, induction nab-paclitaxel and gemcitabine followed by mFOLFIRINOX consolidationis a feasible treatment option for metastatic pancreatic cancer. Despite these advances, it is imperative that we continue towork towards developing additional treatment options that are better tolerated and further prolong survival for thesepatients. This highlight article focuses on the first-line therapy of metastatic pancreatic adenocarcinoma.