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Cancers
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Management of Pancreatic Cancer
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Management of Pancreatic Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 15876

Special Issue Editor

Dr. Traian Dumitrascu

E-Mail Website
Guest Editor
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
Interests: pancreatic adenocarcinoma; pancreatectomy

Special Issue Information

Dear Colleagues,

Pancreatic cancer represents a highly lethal disease and an increasingly common cause of cancer mortality worldwide. Pancreatic ductal adenocarcinoma is the most frequent type of pancreatic cancer. Despite significant achievements in molecular biology, diagnosis, and multi-modal treatment options, most patients are diagnosed with pancreatic cancer at advanced stages, when curative treatment is impossible. Although surgery represents the single hope for long-term survival in patients diagnosed with resectable pancreatic cancer, resection usually implies complex surgical procedures with high morbidity, non-neglectable mortality rates, and disappointing long-term survival. Thus, the surgeon's role in the curative-intent treatment of a patient diagnosed with pancreatic cancer is of utmost importance. However, only a small number of patients are suitable for resection. Furthermore, for locally advanced and metastatic pancreatic cancer, the prognosis is even worse. Therefore, identifying new therapeutical options and an early diagnosis appear to be critical for maximizing therapeutic efficacy and avoiding unnecessary aggressive therapies in pancreatic cancer. New pathways are needed to increase survival in pancreatic cancerin pancreatic cancer, from clinical studies to translational research aiming to identify the best therapeutic method for different clusters of patients with pancreatic cancer. Thus, surgical, imaging, pathological, molecular, and oncological research could drive the discovery of new therapeutic approaches against pancreatic cancer. Potential topics of this Special Issue will include, but are not limited to, the following:

  • Molecular and pathological aspects of pancreatic cancer (adenocarcinoma and its variants, neuroendocrine carcinomas);
  • Modern diagnosis of pancreatic cancer to further guide the multi-modal treatment;
  • Surgical treatment modalities and outcomes of pancreatic cancer;
  • Vascular resections in pancreatic cancer;
  • Medical oncological treatment options in pancreatic cancer;
  • Role of neoadjuvant and adjuvant therapies in pancreatic cancer;
  • Palliative therapy in pancreatic cancer;
  • Survival in pancreatic cancer.

Dr. Traian Dumitrascu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic cancer
  • adenocarcinoma
  • neuroendocrine carcinomas
  • molecular and pathological aspects
  • diagnosis
  • medical treatment
  • palliative therapy

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Published Papers (8 papers)

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Research

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10 pages, 797 KiB  
Article
Obesity Is Associated with Distal Migration of Pancreatic Adenocarcinoma to Body and Tail: A Multi-Center Study
by Wisam Sbeit, Gil Gershovitz, Amir Shahin, Shhady Shhadeh, Mahmoud Salman, Maamoun Basheer and Tawfik Khoury
Cancers 2024, 16(2), 359; https://doi.org/10.3390/cancers16020359 - 14 Jan 2024
Viewed by 1234
Abstract
(1) Background: Pancreatic adenocarcinoma (PAC) is one of the most lethal types of cancer. Most cases of PAC occur in the head of the pancreas. Given the proximity of the pancreatic head to the bile duct, most patients present clinically during early stages [...] Read more.
(1) Background: Pancreatic adenocarcinoma (PAC) is one of the most lethal types of cancer. Most cases of PAC occur in the head of the pancreas. Given the proximity of the pancreatic head to the bile duct, most patients present clinically during early stages of the disease, while distally located PAC could have delayed clinical presentation. (2) Aims: To assess predictors of non-head PAC. (3) Methods: A retrospective multicenter study was conducted, including all patients who had endoscopic ultrasound (EUS) for pancreatic masses and who had histologic confirmation of PAC. (4) Results: Of the 151 patients included, 92 (60.9%) had pancreatic head cancer, and 59 (39.1%) had distal pancreatic cancer. PAC at body was the most common location in the distal PAC group (31 patients (52.5%)). Logistic regression analysis demonstrated a significant association of obesity with distal migration of PAC (OR 4.44, 95% CI 1.15–17.19, p = 0.03), while none of the other assessed parameters showed a significant association. Notably, abdominal pain was more significantly associated with distal PAC vs. head location (OR 2.85, 95% CI 1.32–6.16, p = 0.008). (5) Conclusions: Obesity shows a significant association as a clinical predictor of distal PAC. Further studies are needed to better explore this association. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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21 pages, 4952 KiB  
Article
Neutralization of p40 Homodimer and p40 Monomer Leads to Tumor Regression in Patient-Derived Xenograft Mice with Pancreatic Cancer
by Monica Sheinin, Susanta Mondal and Kalipada Pahan
Cancers 2023, 15(24), 5796; https://doi.org/10.3390/cancers15245796 - 11 Dec 2023
Cited by 1 | Viewed by 2846
Abstract
Pancreatic cancer is a highly aggressive cancer with a high mortality rate and limited treatment options. It is the fourth leading cause of cancer in the US, and mortality is rising rapidly, with a 12% relative 5-year survival rate. Early diagnosis remains a [...] Read more.
Pancreatic cancer is a highly aggressive cancer with a high mortality rate and limited treatment options. It is the fourth leading cause of cancer in the US, and mortality is rising rapidly, with a 12% relative 5-year survival rate. Early diagnosis remains a challenge due to vague symptoms, lack of specific biomarkers, and rapid tumor progression. Interleukin-12 (IL-12) is a central cytokine that regulates innate (natural killer cells) and adaptive (cytokine T-lymphocytes) immunity in cancer. We demonstrated that serum levels of IL-12p40 homodimer (p402) and p40 monomer (p40) were elevated and that of IL-12 and IL-23 were lowered in pancreatic cancer patients compared to healthy controls. Comparably, human PDAC cells produced greater levels of p402 and p40 and lower levels of IL-12 and IL-23 compared to normal pancreatic cells. Notably, neutralization of p402 by mAb a3-1d and p40 by mAb a3-3a induced the death of human PDAC cells, but not normal human pancreatic cells. Furthermore, we demonstrated that treatment of PDX mice with p402 mAb and p40 mAb resulted in apoptosis and tumor shrinkage. This study illustrates a new role of p402 and p40 monomer in pancreatic cancer, highlighting possible approaches against this deadly form of cancer with p402 and p40 monomer immunotherapies. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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12 pages, 270 KiB  
Article
The Unmet Needs of Pancreatic Cancer Carers Are Associated with Anxiety and Depression in Patients and Carers
by Thi N. T. Huynh, Gunter Hartel, Monika Janda, David Wyld, Neil Merrett, Helen Gooden, Rachel E. Neale and Vanessa L. Beesley
Cancers 2023, 15(22), 5307; https://doi.org/10.3390/cancers15225307 - 7 Nov 2023
Viewed by 2505
Abstract
Pancreatic cancer has one of the lowest survival rates, and patients experience debilitating symptoms. Family carers provide essential daily care. This study determined the prevalence of and risk factors for unmet supportive care needs among carers for pancreatic cancer patients and examined which [...] Read more.
Pancreatic cancer has one of the lowest survival rates, and patients experience debilitating symptoms. Family carers provide essential daily care. This study determined the prevalence of and risk factors for unmet supportive care needs among carers for pancreatic cancer patients and examined which carer needs were associated with anxiety and depression in carers and patients. Eighty-four pancreatic cancer patients and their carers were recruited. The carers completed a needs survey (SCNS-P&C). Both carers and patients completed the Hospital Anxiety and Depression Scale. Log binomial regression was used to identify associations between carer needs and anxiety and depression among carers and patients. The top 10 moderate-to-high unmet needs reported by ≥28% of carers were related to healthcare (e.g., discussing concerns with doctors) and information need domains (e.g., information about a patient’s physical needs), plus one other item related to hospital parking. Being male or caring for a patient within 4 months of their diagnosis were associated with greater unmet needs. Some unmet needs, including ‘accessing information about treatments’ and ‘being involved in patient care’, were associated with both carers and patients having anxiety and depression. Carers should be involved in health care consultations and provided with information and opportunities to discuss concerns. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
11 pages, 1074 KiB  
Article
Real-Life Results of Palliative Chemotherapy in Metastatic Pancreatic Ductal Adenocarcinoma
by Bianca Varzaru, Razvan A. Iacob, Adina E. Croitoru, Speranta M. Iacob, Cristina E. Radu, Stefania M. Dumitrescu and Cristian Gheorghe
Cancers 2023, 15(13), 3500; https://doi.org/10.3390/cancers15133500 - 5 Jul 2023
Cited by 3 | Viewed by 1385
Abstract
Purpose: To assess the efficacy of FOLFIRINOX(FFX), gemcitabine-based regimens (GB), and gemcitabine monotherapy (Gem) in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). Methods: This is a retrospective study that included 83 patients with mPDAC treated with first-line chemotherapy (L1) with either FFX, GB [...] Read more.
Purpose: To assess the efficacy of FOLFIRINOX(FFX), gemcitabine-based regimens (GB), and gemcitabine monotherapy (Gem) in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). Methods: This is a retrospective study that included 83 patients with mPDAC treated with first-line chemotherapy (L1) with either FFX, GB or Gem between 2015 and 2017. Progression-free survival (PFS) for L1 and second-line chemotherapy (L2) (PFS-L1 and PFS-L2) and overall survival (OS) were estimated using the Kaplan–Meier method. Results: Median PFS-L1 for FFX, GB and Gem groups was 9 months (95% (Confidence Interval) CI 2.76–15.24), 5 months (95%CI 3.44–6.56), and 5 months (95%CI 3.76–6.24), respectively (p = 0.04). OS was 14 months (95%CI 11.16–16.85), 12 months (95%CI: 9.44–11.56), and 7 months (95%CI: 5.7–8.3) for patients treated with FFX, GB, and Gem, respectively (p = 0.0001). ECOG-PS (0/1) (Hazard Ratio (HR) 6.74, p = 0.002), age > 70 years (HR 0.25, p = 0.04), body tumors (HR 2.8, p = 0.048), CA19–9 > 39 U/mL (HR 0.26, p = 0.02), and neutrophil-to-lymphocyte ratio (NLR) > 4.15 (HR 6.76, p = 0.001) were independent prognostic factors for PFS-L1. Male gender (HR 3.02, p = 0.026), ECOG-PS (0/1) (HR 4.21, p = 0.003), L1 with FFX (HR 0.255, p = 0.007), and NLR > 4.15 (HR 2.65, p = 0.04) were independent prognostic factors of OS. PFS-L2 (HR 6.91, p = 0.013) and OS-L2 (HR 6.95, p = 0.037) were significantly higher in patients first treated with FFX. Conclusions: The OS of patients who receive FFX or GB is comparable. The best PFS-L1 belongs to the FFX group. Male gender, ECOG-PS 0/1, the FFX regimen, and NLR > 4.15 were independent predictors of OS. PFS-L2 and OS-L2 were favorably impacted by L1 with FFX. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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Review

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13 pages, 1137 KiB  
Review
Exploring the Horizon: Anti-Fibroblast Growth Factor Receptor Therapy in Pancreatic Cancer with Aberrant Fibroblast Growth Factor Receptor Expression—A Scoping Review
by Elena Orlandi, Massimo Guasconi, Stefano Vecchia, Serena Trubini, Mario Giuffrida, Manuela Proietto, Elisa Anselmi, Patrizio Capelli and Andrea Romboli
Cancers 2024, 16(16), 2912; https://doi.org/10.3390/cancers16162912 - 22 Aug 2024
Viewed by 943
Abstract
Pancreatic cancer is a highly lethal disease, often diagnosed at advanced stages, with a 5-year overall survival rate of around 10%. Current treatments have limited effectiveness, underscoring the need for new therapeutic options. This scoping review aims to identify and summarize preclinical and [...] Read more.
Pancreatic cancer is a highly lethal disease, often diagnosed at advanced stages, with a 5-year overall survival rate of around 10%. Current treatments have limited effectiveness, underscoring the need for new therapeutic options. This scoping review aims to identify and summarize preclinical and clinical studies on FGFR (Fibroblast Growth Factor Receptor) inhibitors, including tyrosine kinase inhibitors (TKIs) and FGFR-specific inhibitors, in pancreatic cancer with FGFR alterations. We included studies analyzing efficacy, safety, and survival outcomes in various populations. A comprehensive search across major databases identified 73 relevant studies: 32 preclinical, 16 clinical, and 25 from gray literature. The clinical trials focused primarily on efficacy (20 studies) and safety (14 studies), with fewer studies addressing survival outcomes. FGFR1 was the most studied alteration, followed by FGFR2 and FGFR4. Although FGFR alterations are relatively rare in pancreatic cancer, the available data, including promising real-life outcomes, suggest significant potential for FGFR inhibitors. However, more extensive research is needed to identify the correct genetic drivers and gather robust survival data. Ongoing and future trials are expected to provide more comprehensive insights, potentially leading to improved targeted therapies for pancreatic cancer patients with FGFR alterations. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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26 pages, 1189 KiB  
Review
Gaps and Opportunities in the Diagnosis and Treatment of Pancreatic Cancer
by Miłosz Caban and Ewa Małecka-Wojciesko
Cancers 2023, 15(23), 5577; https://doi.org/10.3390/cancers15235577 - 25 Nov 2023
Cited by 5 | Viewed by 2196
Abstract
Pancreatic cancer is one of the leading causes off cancer-related deaths globally. In Europe, this type of cancer has the lowest survival rate of all cancers. A majority of patients have unresectable or even metastatic disease. In addition, actual therapeutic options are not [...] Read more.
Pancreatic cancer is one of the leading causes off cancer-related deaths globally. In Europe, this type of cancer has the lowest survival rate of all cancers. A majority of patients have unresectable or even metastatic disease. In addition, actual therapeutic options are not curative, and surgical treatment is associated with high post-operative morbidity and a lack of uniform translation of surgical success into long-term survival. Moreover, there is no screening for the general population which is recommended, and the overall poor prognosis in pancreatic cancer is related to late clinical detection. Therefore, early diagnosis and early treatment of pancreatic cancer are particularly critical. In this review, we summarize the most significant gaps and opportunities in the diagnosis and treatment of pancreatic cancer to emphasize need for improvement of early detection and the therapeutic efficacy of the available treatment for this cancer. Novel, inclusive, and intentional research is needed to produce improvements in pancreatic cancer in mm the world. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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15 pages, 1347 KiB  
Review
Pancreatic Exocrine Insufficiency and the Gut Microbiome in Pancreatic Cancer: A Target for Future Diagnostic Tests and Therapies?
by James M. Halle-Smith, Lewis A. Hall, Sarah F. Powell-Brett, Nabeel Merali, Adam E. Frampton, Andrew D. Beggs, Paul Moss and Keith J. Roberts
Cancers 2023, 15(21), 5140; https://doi.org/10.3390/cancers15215140 - 25 Oct 2023
Cited by 1 | Viewed by 2151
Abstract
Pancreatic exocrine insufficiency (PEI) is common amongst pancreatic cancer patients and is associated with poorer treatment outcomes. Pancreatic enzyme replacement therapy (PERT) is known to improve outcomes in pancreatic cancer, but the mechanisms are not fully understood. The aim of this narrative literature [...] Read more.
Pancreatic exocrine insufficiency (PEI) is common amongst pancreatic cancer patients and is associated with poorer treatment outcomes. Pancreatic enzyme replacement therapy (PERT) is known to improve outcomes in pancreatic cancer, but the mechanisms are not fully understood. The aim of this narrative literature review is to summarise the current evidence linking PEI with microbiome dysbiosis, assess how microbiome composition may be impacted by PERT treatment, and look towards possible future diagnostic and therapeutic targets in this area. Early evidence in the literature reveals that there are complex mechanisms by which pancreatic secretions modulate the gut microbiome, so when these are disturbed, as in PEI, gut microbiome dysbiosis occurs. PERT has been shown to return the gut microbiome towards normal, so called rebiosis, in animal studies. Gut microbiome dysbiosis has multiple downstream effects in pancreatic cancer such as modulation of the immune response and the response to chemotherapeutic agents. It therefore represents a possible future target for future therapies. In conclusion, it is likely that the gut microbiome of pancreatic cancer patients with PEI exhibits dysbiosis and that this may potentially be reversible with PERT. However, further human studies are required to determine if this is indeed the case. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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Other

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13 pages, 1833 KiB  
Systematic Review
Gestational Diabetes Mellitus and Its Correlation in the Development of Pancreatic Cancer: A 10-Year Systematic Review
by Sophia Tsokkou, Ioannis Konstantinidis, Maria-Nefeli Georgaki, Dimitrios Kavvadas, Kyriaki Papadopoulou, Antonios Keramas, Antonia Sioga, Theodora Papamitsou and Sofia Karachrysafi
Cancers 2024, 16(10), 1840; https://doi.org/10.3390/cancers16101840 - 11 May 2024
Cited by 1 | Viewed by 1472
Abstract
Purpose: Pancreatic cancer (PC) is a fatal malignancy with an aggressive course derived from the cells of pancreatic tissue. Gestational diabetes mellitus (GDM) is a state of spontaneous hyperglycemia occurring during gestation and has been suggested as a risk factor PC. Women with [...] Read more.
Purpose: Pancreatic cancer (PC) is a fatal malignancy with an aggressive course derived from the cells of pancreatic tissue. Gestational diabetes mellitus (GDM) is a state of spontaneous hyperglycemia occurring during gestation and has been suggested as a risk factor PC. Women with a history of GDM revealed a risk rate of 7.1% for the development of PC. The current systematic review aims to investigate the correlation between GDM and the degree to the prevalence of PC. Methodology: For this systematic review, the PICO model was prepared to construct and outline the exact questions of the study, a PRISMA flow diagram was prepared and quality assessment was conducted using the Newcastle Ottawa Scale (NOS) for Cohort Studies, the NIH Quality Assessment Tool-Criteria for Case Reports and the Cochrane quality assessment tool for Systematic Reviews and Meta-analysis studies. Result: A total of eight articles were retrieved from the main databases, and a table was created to summarize the information found. Even though the data found were limited, the quality assessment performed revealed that the articles were of high validity. Conclusions: It can be concluded that GDM has an association with the development of PC and can be considered as a risk factor. Full article
(This article belongs to the Special Issue Management of Pancreatic Cancer)
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