Beyond improving survival in metastatic disease, clinicians leverage liposomal irinotecan's high tumor shrinkage rate to make borderline resectable or locally advanced pancreatic cancer patients eligible for curative surgery. This strategic use aims to increase the small percentage of patients who can achieve a cure.
Clinicians avoid using irinotecan-based regimens for first-line metastatic pancreatic cancer if the patient previously received irinotecan as an adjuvant therapy and experienced a rapid recurrence. This treatment history is a key factor in sequencing decisions, overriding standard first-line protocols.
With only one-third of pancreatic cancer patients advancing to second-line treatment, oncologists must carefully select first-line therapies. This may involve choosing less toxic combinations to preserve patient fitness for subsequent treatments, like emerging KRAS inhibitors, rather than using the most aggressive option upfront.
The future of treating advanced pancreatic cancer involves innovative, localized approaches beyond systemic chemotherapy. These include phototherapy to destroy tumor tissue around key blood vessels and transarterial perfusion for direct chemotherapy delivery, aiming to make more patients operable and improve outcomes.