Cáncer de páncreas localizado y localmente avanzado

Alfredo Carrato Catedrático y Jefe Servicio de Oncología Médica

Hospital Universitario Ramón y Cajal

Disclosures

Advisory Boards:- Merck, Roche, MSD, Pfizer, Bayer, Shire, Servier,

Celgene, Amgen

Research funds:- Celgene, Shire, Amgen

Recorded (2001–2010) and projected (up to 2025) number of breast and pancreatic cancer deaths (both males and females) in the EU.

J. Ferlay; C. Partensky; F. Bray; More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncologica 2016, 55, 1158-1160.

FRENTES EN LA LUCHA CONTRA EL CÁNCER

• Prevención primaria (Hábitos saludables, fármacos, cirugía, etc.)

• Prevención Secundaria (Diagnóstico precoz o cribado)

• Mejor diagnóstico (Tecnología de Imagen, Anatomía Patológica)

• Aumento de conocimientos sobre la biología del cáncer (Incremento de la investigación básica, traslacional y clínica)

• Mejorando el tratamiento:

– Tratamientos individualizados: Oncología de precisión

– Trabajo asistencial multidisciplinar

– Participación en ensayos clínicos

– Atención integral del paciente

Pancreatic Ductal Adenocarcinoma

(PDAC) unmet needs - 1

• PDAC awareness: “Cure” rate is only 5-7%

• Primary prevention: 80% of patients are diagnosed with

advanced unresectable disease

• Lack of screening programs for an earlier diagnosis

– no high-risk population defined yet

– Non invasive methods are needed (liquid biopsy)

• Improvement in diagnosis

– Some patients are diagnosed only by imaging

– Biopsies are scanty & cytology is performed in >50% of

cases (possible misinterpretation)

Pancreatic Ductal Adenocarcinoma

(PDAC) unmet needs - 2

• Non existence of a health plan for assistance

– Networking & high-volume centers

– Nº of lymph nodes resected: UICC:10, ESMO:15

• Non existence of a health program for research

– No professionalized biobanks

– Research funds for PDAC are low at the EU (2%

of cancer research funds)

– $5.26 billion for the National Cancer Institute for

2015 (neglected cancer)

APACT PDAC adjuvant trial

Adjuvant trials

In this single-arm phase 2 trial of 49 patients, the R0 resection rate was 61% among all eligible participants. Thirty-fourof 49 patients underwent surgical resection, with 30 of 49achieving R0 resection in this subset

Cancers 2019, 11, 278; doi:10.3390/cancers11030278

Asiatic Experience

Mayo Clinic experience

Ongoing trials

Promising approaches

• PDAC screening in high-risk groups

• PDAC molecular subtypes & tailored treatment

• DNA damage repair strategies: platinum, PARP inh.

• Stromal alterations approaches: Opportunity may exist outside the cancer cell: Hyaluronidase

• Immune therapy: MSI, vaccines….

• Microbiota management

• RAS? May be, in mice (Cancer Cell. 2019 Apr 15;35(4):573-587)

Familial Pancreatic Cancer Screening Protocol

Yearly EUS & MRI (CT) + CA19-9/CEA +blood sample collection

EUS + MRI Normal

EUS or MRIIAbnormal

Repeat imaging annuallyMultidisciplinary team

evaluation (oncologists, surgeons, gastroenterologists,

radiologists, pathologists)

Treatment selection

Therapeutic Opportunities for PDAC

Dreyer et al Clin Can Res 2017;23:1638-46

¡¡¡Gracias!!!