Prise en charge des adénocarcinomes du pancréas métastatiques en 2024.

Pancreatic ductal adenocarcinoma (PDAC) remains the gastrointestinal cancer with the worst prognosis. When metastases are present (mPDAC), stage the most common at diagnosis, the treatment lays on supportive cares to improve denutrition, pain and physical alteration associated with polychemotherapy regimens: FOLFIRINOX (FFX), gemcitabine plus NabPaclitaxel (GNP –Not reimbursed in France). Important gastrointestinal and hematological side effects associated with that regimens reserves them for patients with good performans status. Second line (L2) is generally in mirror with the first one (L1) with administration of 5-FU based regimen plus oxaliplatin or irinotecan (that can be the nanoliposmal form NALIRI – not reimbursed in France) for patient treated with GNP in L1 and gemcitabine +/-(Nab) paclitaxel for those treated with FFX in L1. Main innovations in mPDAC have occurred in specific subgroups identified using the tumors molecular portrait. PDAC with constitutional mutation of BRCA (4%-8%) is accessible to olaparib in maintenance after four months of platinum-based regimen and without progressive disease. Patients with MSI-H/dMMR (1%) or mutated for KRASG12C (< 1%) tumors can be treated by anti-PD1 or specific inhibitors in clinical trials. Huge effort of researchers and clinicians to identify PDAC biomarkers driven subgroups and to personalized treatment strategies for them will probably be the key to improve PDAC's prognosis. [ABSTRACT FROM AUTHOR]