Cancer du pancréas localement avancé

Approximately 30% of pancreatic adenocarcinoma are diagnosed in a locally advanced form (CPLA). This particular entity, intermediate between resectable and metastatic cancers, is defined by the importance of contact between the tumor and the main peripancreatic vessels. Due to this particularity, therapeutic approach is not well standardized. Until 2011, the treatment strategy remained limited to a first-line palliative metastatic chemotherapy, gemcitabine, with poor results, since a prompt progression to a metastatic form was observed in 30% of cases. Since the publication of the results of FOLFIRINOX study and gemcitabine-nab-paclitaxel combination as first-line therapy of metastatic form, the therapeutic possibilities of CPLA have been enriched. The use of these chemotherapies in CPLA, initially on the basis of non-comparative retrospective studies or phase 2 studies with small effectives, has been supported by the recent results of the phase 3 NEOPAN study, demonstrating the superiority of FOLFIRINOX on gemcitabine. For the majority of patients whose tumor remains unresectable but non-progressive after induction chemotherapy, closure chemoradiotherapy is sometimes proposed, which remains controversial. To better understand the chemoresistance mechanisms of these tumors, intensify chemotherapy or use more efficient techniques of radiation therapy in order to increase the dose received by the tumor tissue, evolve imaging techniques towards functional imaging, identify prognostic factors and predictive are challenges that remain to be addressed. The inclusion of patients with CPLA in therapeutic trials asking clinical and translational questions is an essential condition to hope to meet this challenge.