Pancreatic Lift and Pancreatic Movement Professor Wang Liwei: ASCO's two major studies explore new directions for pancreatic cancer in the future

*Only for medical professionals to read and reference.
At the 2021 ASCO conference, what is the new progress in the research of advanced pancreatic ductal adenocarcinoma and locally advanced pancreatic cancer? Pancreatic cancer is one of the most malignant tumors of the digestive tract, with insidious onset and rapid progress [1]
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Early diagnosis of pancreatic cancer is difficult.
Most patients are already at an advanced stage when they are diagnosed, and they have lost the opportunity for surgery
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Even if the patient undergoes surgical resection, the 5-year survival rate is still less than 20%, and the prognosis is not optimistic [1,2]
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In recent years, with the continuous improvement of medical standards, the field of pancreatic cancer treatment has made rapid progress.
In response to the two research results announced at the 2021 American Society of Clinical Oncology (ASCO) meeting, the "medical community" invited the Shanghai Jiaotong University School of Medicine Professor Wang Liwei, director of the Oncology Department of Renji Hospital, conducted professional combing and comments
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ctDNA plasma analysis guides clinical decision-making in advanced pancreatic cancer, and helps predict the clinical prognosis of pancreatic ductal adenocarcinoma (PDAC), which accounts for about 90% of the incidence of pancreatic cancer, and its treatment effect and prognosis are extremely poor
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Surgical resection is currently the only effective treatment method, but unfortunately, many patients are already at an advanced stage when discovered, and only 20%-30% of patients have the opportunity of surgical resection [3]
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Therefore, the early diagnosis of tumors is very important.
However, there is no reliable screening tool to identify high-risk patients
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In recent years, blood biomarkers in the form of DNA have shown great potential for cancer diagnosis and treatment plan guidance.
Circulating tumor DNA (ctDNA) has gradually become a new potential detection method that can verify PDAC from non-malignant diseases.

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A retrospective analysis of the ASCO Conference in 2021 included 104 PDAC patients treated at Miaoyou Medical International Clinic, and 140 samples were collected.
During the routine clinical diagnosis and treatment from 2017 to 2020, all patients underwent ctDNA analysis.

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The study analyzed the correlation between progression-free survival (PFS) and overall survival (OS) and ctDNA test results [4]
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The results of the study showed that the metastasis of various parts of PDAC (liver, bone, lung, and peritoneum) is related to biomarkers such as KRAS and TP53
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Figure 1.
The relationship between the incidence of metastasis in each site and the existence of mutations.
Two or more systemic mutations are associated with shorter PFS and OS, which may mean that PDAC patients with genetic mutations have a worse prognosis
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Figure 2.
The relationship between PFS, OS and mutations Compared with locally advanced disease, CCND2, SMAD, KRAS and TP53 mutations are more likely to appear in metastatic disease
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Figure 3.
The relationship between gene mutation and disease stage.
Therefore, ctDNA plasma analysis based on next-generation sequencing is a viable alternative when advanced PDAC patients cannot undergo pathological biopsy.
ctDNA plasma analysis can collect comprehensive genomic data for PDAC patients The real-time treatment plan guidance has potentially important impact and helps predict long-term prognosis
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Regarding ctDNA plasma analysis, Professor Wang Liwei said: "Pathological biopsy is the gold standard for diagnosing pancreatic cancer.
Although traditional tissue biopsy can provide valuable information, pancreatic tissue sampling is difficult, invasive, and impossible to repeat biopsy, which greatly limits real-time biopsy.
The opportunity to monitor and apply personalized medicines
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Patients urgently need a minimally invasive, effective, and simple method for early diagnosis, prognostic stratification, and tumor monitoring
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Liquid biopsy is convenient for sampling, can obtain more comprehensive biological characteristics and information in the sample, and has a good prospect in the early diagnosis and predictive efficacy of advanced PDAC
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However, liquid biopsy also has problems and challenges.
Improving specificity and sensitivity is the next goal of liquid biopsy
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"The standard treatment plan for locally advanced pancreatic cancer is still being explored.
Translational therapy has become a research hotspot.
Although more than 40% of pancreatic cancer patients have no distant metastasis, they are accompanied by extensive vascular and lymph node invasion, which cannot be accepted in time.
This stage of tumor is also called locally advanced pancreatic cancer (LAPC)
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At present, for LAPC patients, systemic chemotherapy is the most important treatment option [5]
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Some previous studies have confirmed that FOLFIRINOX (leucovorin, fluorouracil) , Irinotecan and oxaliplatin) and AG (gemcitabine and albumin-bound paclitaxel) for the treatment of LAPC, but there is no randomized controlled trial comparing the efficacy of these two regimens
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In order to select the best LAPC chemotherapy Program, this year's ASCO annual meeting announced a randomized phase II trial (JCOG1407), which compared the effect of modified FOLFIRINOX (mFOLFIRINOX) and AG in LAPC patients [6]
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The study included Japanese from Japan.
126 patients in medical institutions were randomly assigned to mFOLFIRINOX group (group A) (n=62) or AG group (group B) (n=64) for treatment
.
The
results showed that the 1-year OS rate in group B was higher (77.
4) % vs.
82.
5%), but the two-year OS rate of group A was higher (48.
2 vs.
39.
7%), and there was no significant difference in PFS, objective remission rate and other data between the two groups, so it would take longer and more The data clarify the standard treatment plan for LAPC
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Figure 4.
OS, PFS and DMFS in groups A and B.
Figure 5.
Objective response rate and CA19-9 response rate in groups A and B.
LAPC was previously considered unresectable pancreatic cancer.
With the development of neoadjuvant therapy, Some LAPC patients can obtain surgical opportunities through neoadjuvant therapy.
Combined with the results of the JCOG1407 clinical study, Professor Wang Liwei pointed out: "More and more people are paying attention to the conversion therapy of unresectable LAPC patients.
20% of LAPC patients can achieve R0 resection through conversion therapy.
However, most patients still cannot be successfully converted to surgery
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At present, the commonly used treatment options for LAPC are FOLFIRINOX and AG, and the difference in objective efficiency between the two is not significant
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There is still no clinical treatment as to which treatment option to choose .
Clear criteria
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Based on the heterogeneity of pancreatic cancer, 60% of patients have tumor tissues rich in fibrous tissue
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The
AG scheme may be more suitable for pancreatic cancer rich in fibrous tissue, and the FOLFIRINOX scheme may be more suitable for those with a low proportion of fibrous tissue.
Pancreatic cancer
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Clinicians may be able to choose personalized treatment plans based on the different pathological characteristics of patients, and look forward to further research and exploration
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"Looking forward to the research direction of pancreatic cancer-early screening and molecular classification concurrently Professor Wang Liwei summarized the pancreas The future research direction and focus of cancer are: "early screening and molecular typing
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" Most patients with pancreatic cancer are already at an advanced stage when they are diagnosed, and they have lost the opportunity for surgery
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Therefore, it is necessary to achieve early screening for pancreatic cancer.
On the one hand, it is necessary to identify the population at high risk of pancreatic cancer, so as to reduce the scope of screening objects; on the other hand, it is necessary to improve the accuracy of CT and other imaging methods to increase the detection rate of pancreatic cancer
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In addition, liquid biopsy is becoming more and more popular in cancer diagnosis, prognostic judgment and monitoring.
Finding new biomarkers in the body fluid of patients with pancreatic cancer has great development prospects for early diagnosis of the disease
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In lung cancer and breast cancer, the use of targeted therapy based on tumor molecular subtypes can improve the treatment effect and increase the survival time of patients, which provides a basis for tumor precision medicine
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Due to the heterogeneity of pancreatic cancer, a series of studies have carried out molecular classification of pancreatic cancer, and molecular classification will bring new hope for individualized and precise targeted treatment of pancreatic cancer patients
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It is expected that with the continuous advancement of molecular diagnostic technology, the clinical classification diagnosis, individualized treatment, and prognosis evaluation of pancreatic cancer will reach new heights
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The diagnosis and treatment of pancreatic cancer is progressing slowly.
Genetic testing and translational therapy may be one of the breakthroughs in future treatment.
The diagnosis and treatment of pancreatic cancer still has a long way to go, and further exploration is needed
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Expert profile Professor Wang Liwei, Director of Oncology Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Second-level Professor, Chief Physician, Ph.
D.
Supervisor, Member of the MDT Expert Committee of Renji Hospital, Director, Pancreatic Cancer Center, Shanghai Jiaotong University, Chairman, Yangtze River Delta Cancer Specialist Alliance Member of the Chinese Society of Clinical Oncology (CSCO) Council Member of the CSCO Pancreatic Cancer Expert Committee Member of the First Session of the CSCO Pancreatic Cancer Expert Committee Member of the Oncology Branch of the Chinese Medical Association and Leader of the Pancreatic Oncology Group Vice Chairman of the Pancreatic Disease Committee of the Chinese Association of Research Hospitals Vice Chairman of the Shanghai Anti-Cancer Association Chairman and Chairman of the Committee for Difficult Tumors, Chairman of the Shanghai Medical Oncology Branch, Shanghai Leading Talents and Shanghai Outstanding Subject Leaders Mainly engaged in clinical diagnosis, treatment and translational research of digestive system tumors; 2001-2004, University of California, Los Angeles Visiting study at UCLA and MD Anderson Cancer Center
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Presided over the formulation of China’s first "Chinese Expert Consensus on Comprehensive Diagnosis and Treatment of Pancreatic Cancer" and the first "CSCO Guidelines for Pancreatic Cancer Diagnosis and Treatment" of the Chinese Society of Clinical Oncology.
New drug creation projects and more than 10 various fund projects; currently the deputy editor-in-chief of "Journal of Pancreatology", editorial board members of "Cancer Research", "JHO", "Tumor", "Clinical Oncology" and other journals.
He has published more than 100 SCI papers.
Cited more than 1,000 times
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References: [1] Fang Yun, et al.
Current status and prospects of pancreatic cancer drug treatment.
Chinese Journal of Chinese Materia Medica.
2019;44(8):1509-1516.
[2] Cui Hanzhi, et al.
Current status and progress in treatment of advanced pancreatic cancer.
Journal of PLA Medical College.
2020;41(10).
[3] Duan Ruinan, Zhong Xiangyu, Cui Yunfu.
Progress in the treatment of pancreatic ductal adenocarcinoma[J].
World Chinese Journal of Digestion,2016,24(8):1206-1212.
[4 ]Gehan Botrus et al.
Prognostic impact of circulating tumor DNA in advanced pancreatic cancer.
2021ASCO.
[5]Mu Chunhong,Lu Bangce,Ma Pingan.
Folfirinox-based neoadjuvant chemotherapy for locally advanced pancreatic cancer surgery[J ].
Chinese Journal of General Surgery, 2017,26(03):281-288.
[6]Masato Ozaka et al.
Randomized phase II study of modified FOFIRINOX versus gemcitabine plus nab-pacilitaxel combination therapy for locally advanced pancreatic cancer (JCOG1407).
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MSAONCO-E-20210018*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform