Pancreatic cancer is a challenging and complex disease characterized by a dense fibrotic stroma and an immunosuppressive tumor microenvironment.  Until recently, there were no predictive biomarkers to personalize selection of targeted or biologic therapies as a part of standard of care treatment. Moreover, the regulatory immune population of cells creates a “cold”, non-immunogenic tumor that is resistant to immunotherapies including checkpoint inhibitors. However, in the last few years, there has been substantial progress in our understanding of the role mutations in the pathogenesis of disease leading to increased adoption of germline and next generation sequencing to identify mutations and fusions to optimize selection of therapies and select patients for clinical trials of targeted agents.
This book provides a comprehensive, global overview on therapy for pancreatic cancer, exploring approved therapies and focusing on the “Next” in drug development including molecularly targeted therapy and efforts at “Drugging the Undruggable”: the KRAS mutation. It also addresses efforts at targeting the inhospitable stroma to improve drug delivery to the tumor cells, incorporating ct DNA (liquid biopsies) in the care of patients and recent advances in immunotherapy.Pancreatic Cancer: Current Therapeutics and Future Directions will illuminate these challenges, review existing therapeutics, and highlight current and future efforts to improve outcomes in this devastating disease. Useful to physicians, fellows, medical students, residents, physician assistants, nurse practitioners, pharmaceutical companies and researchers interested in pancreatic cancer, it will first explain management of localized disease including resectability and adjuvant and neoadjuvant therapies. Targeted therapies including molecular, immunotherapy, stroma and role of ctDNA or “liquid biopsies” will be addressed. Finally, the book will explore the important role of pain management, diet and exercise in improving outcomes in pancreatic cancer.