Metastatic Pancreatic Cancer

Pancreatic cancer is one of the most aggressive of human malignancies. In the United States, more than 37,000 people develop pancreatic adenocarcinoma each year, and almost all are expected to die from this disease [1], which is the fifth leading cause of cancer death in the country [2]. In Europe, about 40,000 deaths from pancreatic cancer are observed each year [3]. Median survival is only eight to twelve months for patients with locally advanced disease and three to six months for patients with metastatic disease, regardless of the therapy chosen. The overall survival rate is less than 5% [2]. Surgical resection is the only potentially curative treatment for pancreatic cancer. Unfortunately, the disease typically presents late, and therefore by the time a diagnosis is made, only a limited number of patients are candidates for pancreatectomy [4]. In large series of patients, only 5% to 22% were found to have resectable tumors at diagnosis, owing to the presence of advanced local tumor growth, peritoneal spread, or hepatic metastases [5, 6]. IMPORTANCE OF METASTASES The treatment of metastatic disease remains the primary challenge in the treatment of pancreatic malignancy. Although distant metastasis can occur, locoregional metastasis is the most common recurrence or spread. Aggressive behavior, neurotrophic growth, and early spread are the main characteristics of this tumor. Distant spread to the liver, peritoneum, lung, and bones is associated with poor prognosis [7] and with a short median survival of three to six months, depending on the extent of the disease and the performance status [8].