TO PUT THAT INTO CONTEXT
Eileen M. O’Reilly, MD
David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center
Weill Cornell Medical College New York, New YorkPancreatic adenocarcinoma remains fundamentally challenging, although there have been tangible improvements in outcomes over the last couple of years with use of the modern standards of FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel for advanced disease, along with increasing integration of these regimens into earlier-stage disease settings. Weinberg and colleagues have provided a concise summary of current state-ofthe- art treatment, along with a comprehensive, insightful, and topical review of key novel therapeutics in development for pancreatic adenocarcinoma.What Are the Chief New Developments in Pancreatic Cancer Research?
The molecular genomics of the disease have been well depicted of late; there has also been a growing recognition that the epigenome and the tumor microenvironment are critical components that contribute to poor outcomes and that present opportunities for therapeutic exploitation. Strategies capitalizing on homologous repair deficiencies and stromal disruption strategies are highlighted. The prospect of immune therapeutics is on the horizon, and limited data thus far have suggested potential utility in pancreatic adenocarcinoma. As the authors note, the first forays with immune therapies have yielded minimal benefit; however, various combination immune strategies using vaccines, stromal modulating agents, checkpoint inhibitors, and chimeric antigen receptor (CAR) Tcells, all of which are under active investigation, hold promise.What Key Challenge Do Researchers Now Face?
Part of the challenge going forward will be to adopt innovative trial designs, in order to try to evaluate multiple strategies in parallel, as well as investigate possibilities for making informed prioritization decisions. In sum, progress in pancreatic adenocarcinoma has historically been slow, yet while current standard practice is not imminently changing, the explosion of development of novel therapeutics based on sound science, along with a resurgence of interest by the research and pharmaceutical communities, collectively position the field for progress.Financial Disclosure: Dr. O'Reilly consults for and receives research funding from Celgene. She has no other relevant disclosures.