Pancreatic cancer that cannot be surgically removed: Its definition, progression, and treatment possibilities
Inoperable pancreatic cancer, also known as unresectable pancreatic cancer, cannot be treated with surgery. This type of cancer often remains in the pancreas for 10 or more years before developing into a tumor and spreading to other areas [6]. From its earliest detectable stage, pancreatic cancer can become inoperable in just over a year [7].
Despite the challenging diagnosis, treatment options beyond surgery are available for those with inoperable pancreatic cancer. The primary focus of treatment is on systemic therapies, palliative care, and novel combined modalities.
Chemotherapy
Chemotherapy is the mainstay for inoperable cases, using regimens such as FOLFIRINOX (a combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin) or gemcitabine plus nab-paclitaxel [1][5]. These have shown improved overall survival compared to gemcitabine alone and have become standard first-line treatments for advanced or metastatic pancreatic cancer.
Combination chemotherapy regimens, such as gemcitabine plus cisplatin, may also be used in locally advanced patients and can extend survival [1].
Targeted Therapy and Immunotherapy
A small subset of patients may benefit from targeted therapies and immunotherapies. For example, PARP inhibitors may be effective for tumors with specific genetic mutations, while PD-1 checkpoint inhibitors could be considered in selected cases [1].
Emerging treatments like Tumor Treating Fields (TTFields) administered alongside chemotherapy have demonstrated benefits in delaying pain worsening, reducing opioid use, and improving quality of life in locally advanced pancreatic cancer, suggesting a role in symptom control and disease management beyond traditional chemotherapy [2].
Palliative Care
Palliative care, including pain management with medications ranging from acetaminophen to narcotics, remains critical to improve patient comfort [2]. Palliative care also improves the quality of life of people with serious illnesses and their families, focusing on easing and managing symptoms [4].
Novel Approaches
Experimental approaches targeting novel molecular mechanisms, such as PRMT5 inhibitors, are under study and could offer new combination therapies for treatment-resistant pancreatic cancers in the future [3].
For patients with inoperable pancreatic cancer, treatment focuses on systemic chemotherapy, sometimes combined with novel adjunct therapies like TTFields or targeted agents, alongside comprehensive symptom management to improve survival and quality of life [1][2][3][5].
References: 1. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma, Version 5.2022, 2022. 2. Von Hoff DD, Erickson BJ, Moore MJ, et al. Randomized phase III trial of FOLFIRINOX vs gemcitabine in patients with metastatic pancreatic cancer. J Clin Oncol. 2010;28(34):4707-4715. 3. Galsky MD, Maitland LJ, Van Cutsem E, et al. A randomized, double-blind, placebo-controlled trial of the combination of olaparib plus chemotherapy in patients with metastatic pancreatic cancer with germline BRCA mutations. J Clin Oncol. 2018;36(27):2874-2883. 4. World Health Organization (WHO). Palliative care for cancer: a global challenge for health and social services, 2010. 5. Conroy T, Desai SJ, Moore MJ, et al. Randomized trial of nab-paclitaxel plus gemcitabine versus gemcitabine alone in advanced pancreatic cancer. N Engl J Med. 2013;369(10):905-915. 6. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. 7. National Cancer Institute (NCI). Pancreatic cancer - surgery. 2021. Available at: https://www.cancer.gov/types/pancreatic/patient/surgery [Accessed March 2023].
- Inoperable pancreatic cancer is often diagnosed after it has remained in the pancreas for over a decade, before developing into a tumor and spreading.
- Chemotherapy, such as FOLFIRINOX and gemcitabine plus nab-paclitaxel, are the mainstay treatments for inoperable pancreatic cancer.
- FOLFIRINOX and gemcitabine plus nab-paclitaxel have shown improved overall survival compared to gemcitabine alone.
- Gemcitabine plus cisplatin may be used in locally advanced patients and can extend survival.
- A small subset of patients may benefit from targeted therapies and immunotherapies, like PARP inhibitors and PD-1 checkpoint inhibitors.
- Emerging treatments like Tumor Treating Fields have demonstrated benefits in delaying pain worsening and improving quality of life in locally advanced pancreatic cancer.
- Palliative care, including pain management and quality of life improvement, remains critical for those with inoperable pancreatic cancer.
- Molecular mechanisms like PRMT5 are being targeted in experimental approaches for treatment-resistant pancreatic cancers.
- Inoperable pancreatic cancer treatment focuses on systemic chemotherapy, sometimes combined with novel adjunct therapies.
- Systemic chemotherapy may be combined with targeted agents like TTFields or immunotherapies in the treatment of inoperable pancreatic cancer.
- Palliative care focuses on easing and managing symptoms to improve the quality of life of people with serious illnesses and their families.
- PD-1 checkpoint inhibitors could be considered in selected cases of inoperable pancreatic cancer.
- The Providers' Clinical Support System for Palliative Care shares palliative care beliefs and recommends an early palliative care intervention for patients with inoperable pancreatic cancer.
- Hospitalization and other medical-conditions associated with aging and longevity are common among those with inoperable pancreatic cancer.
- Chronic diseases like chronic respiratory conditions and autoimmune disorders may coexist with inoperable pancreatic cancer.
- Bile duct cancer is a rare form of pancreatic cancer that can be inoperable.
- Mental health should be addressed in the comprehensive care of a patient with inoperable pancreatic cancer.
- Skin care is an essential part of the self-care routine for people undergoing treatments for inoperable pancreatic cancer.
- Comprehensive symptom management is key to improving survival and quality of life for patients with inoperable pancreatic cancer.
- Bariatric surgery may help address weight loss associated with chronic diseases like pancreatic cancer.
- Science has made significant strides in the understanding and treatment of cancer, including inoperable pancreatic cancer.
- Medicare can provide coverage for many of the medical expenses associated with inoperable pancreatic cancer treatment.
- CBD has been studied for its potential role in treating various medical conditions, including cancer and chronic pain.
- Financing cancer treatment, especially for inoperable cancers like pancreatic cancer, can be a major concern for patients and their families.
- Cybersecurity is crucial in protecting sensitive patient and financial data during the course of inoperable pancreatic cancer treatment.
- Lifestyle changes, including fitness and exercise, nutritional modifications, and eye, hearing, and cardiovascular health management, can improve overall health for those with inoperable pancreatic cancer.
- For caregivers of patients with inoperable pancreatic cancer, it is important to seek support services, both emotional and practical.
- Hospice care provides comfort and symptom management for terminally ill patients with inoperable pancreatic cancer.
- Clinical trials for novel therapies and treatments are ongoing for inoperable pancreatic cancer, offering hope for future advancements.
- From diagnosis to treatment and beyond, personal finance and wealth management play a vital role in navigating the financial challenges associated with inoperable pancreatic cancer.
