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pancreatitis advances in management

Rodrigo Toledo, Camilo Jimenez
Inactivating mutations of the succinate dehydrogenase subunit B ( SDHB ) gene and the subsequent stabilization and activation of the hypoxia-inducible factor 2-alpha (HIF2α) unit are recognized hallmarks associated with the development of metastatic pheochromocytomas and paragangliomas (MPPG). Despite this discovery, the development of systemic therapies for patients with MPPG has been very slow. The rarity of the disease, the lack of preclinical animal models, and the impracticable development of large clinical trials has hindered the therapeutic progress for MPPG...
2018: F1000Research
F Huguet, E Rivin Del Campo, D Antoni, V Vendrely, P Hammel
At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated...
August 9, 2018: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Sally C Lau, Omar Abdel-Rahman, Winson Y Cheung
Gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) represent a heterogeneous group of tumors that is associated with an indolent course. Octreotide has a positive effect on disease stabilization in well-differentiated midgut NETs, but a meaningful survival analysis was not possible due to insufficient events. Higher doses of octreotide long-acting release (LAR) are often used in clinical practice for control of carcinoid symptoms and our objective was to determine if dose of octreotide correlates with survival...
August 4, 2018: Medical Oncology
Vincent Drubay, Nicolas Skrypek, Lucie Cordiez, Romain Vasseur, Céline Schulz, Nihad Boukrout, Belinda Duchêne, Lucie Coppin, Isabelle Van Seuningen, Nicolas Jonckheere
Pancreatic adenocarcinoma (PDAC) is one of the most deadly cancers in the Western world because of a lack of early diagnostic markers and efficient therapeutics. At the time of diagnosis, more than 80% of patients have metastasis or locally advanced cancer and are therefore not eligible for surgical resection. Pancreatic cancer cells also harbour a high resistance to chemotherapeutic drugs such as gemcitabine that is one of the main palliative treatments for PDAC. Proteins involved in TGF-β signaling pathway (SMAD4 or TGF-βRII) are frequently mutated in PDAC (50⁻80%)...
July 31, 2018: Cancers
Paola Di Giacinto, Francesca Rota, Laura Rizza, Davide Campana, Andrea Isidori, Andrea Lania, Andrea Lenzi, Paolo Zuppi, Roberto Baldelli
Background . Neuroendocrine tumors (NETs) are characterized by having behavior and prognosis that depend upon tumor histology, primary site, staging, and proliferative index. The symptoms associated with carcinoid syndrome and vasoactive intestinal peptide tumors are treated with octreotide acetate. The PROMID trial assesses the effect of octreotide LAR on the tumor growth in patients with well-differentiated metastatic midgut NETs. The CLARINET trial evaluates the effects of lanreotide in patients with nonfunctional, well-, or moderately differentiated metastatic enteropancreatic NETs...
2018: International Journal of Endocrinology
Emily K Martin, Neal Bhutiani, Michael E Egger, Prejesh Philips, Charles R Scoggins, Kelly M McMasters, Lawrence R Kelly, Gary C Vitale, Robert C G Martin
BACKGROUND: Irreversible electroporation (IRE) has successfully been used for palliation of pancreatic and liver cancers due to its ability to ablate tumors without destroying nearby vital structures. To date, it has not been evaluated in patients with advanced hilar cholangiocarcinoma (AHC). This study presents a single-institution experience with IRE for management of obstructive jaundice in AHC. METHODS: A single-institution database was queried for patients undergoing IRE for AHC after PTBD placement for relief of obstructive jaundice from 2010 to 2017 and compared to a control group treated with standard of care only (No IRE)...
July 26, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Wen Zhang, Chunxia Du, Yongkun Sun, Lin Yang, Chengxu Cui, Zhichao Jiang, Chengfeng Wang, Jinwang Wang, Aiping Zhou
PURPOSE: We conducted a single-arm prospective phase II study to determine the efficacy and safety of the first-line treatment of advanced pancreatic cancer with nab-paclitaxel and S-1 followed by S-1 maintenance therapy. METHODS: Nab-paclitaxel was administered intravenously on days 1 and 8 at 120 mg/m2 . S-1 at 120 mg/day (for surface area ≥ 1.5 m2 ), 100 mg/day (for surface area between 1.25-1.5 m2 ), and 80 mg/day (for surface area < 1.25 m2 ) were given two times daily on days 1-14 every 3 weeks...
July 23, 2018: Cancer Chemotherapy and Pharmacology
(no author information available yet)
Pancreatic cancer ranks the fifth leading cause of cancer-related death, while the incidence has increased in the recent years.Although available diagnosis and treatment have failed to significantly improve patients' outcome, some advances have been made along with the understanding of the new concepts from oncology over the past several years.Pancreatic Cancer Committee of Chinese Anti-Cancer Association worked out this latest edition of "The Clinical Practice Guidelines for Pancreatic Cancer(version 2018)" based on current situation to standardize and improve the diagnosis and treatment of pancreatic cancer in China...
July 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Luca Gianotti, Marc G Besselink, Marta Sandini, Thilo Hackert, Kevin Conlon, Arja Gerritsen, Oonagh Griffin, Abe Fingerhut, Pascal Probst, Mohamed Abu Hilal, Giovanni Marchegiani, Gennaro Nappo, Alessandro Zerbi, Antonio Amodio, Julie Perinel, Mustapha Adham, Massimo Raimondo, Horacio J Asbun, Asahi Sato, Kyoichi Takaori, Shailesh V Shrikhande, Marco Del Chiaro, Maximilian Bockhorn, Jakob R Izbicki, Christos Dervenis, Richard M Charnley, Marc E Martignoni, Helmut Friess, Nicolò de Pretis, Dejan Radenkovic, Marco Montorsi, Michael G Sarr, Charles M Vollmer, Luca Frulloni, Markus W Büchler, Claudio Bassi
BACKGROUND: The optimal nutritional therapy in the field of pancreatic surgery is still debated. METHODS: An international panel of recognized pancreatic surgeons and pancreatologists decided that the topic of nutritional support was of importance in pancreatic surgery. Thus, they reviewed the best contemporary literature and worked to develop a position paper to provide evidence supporting the integration of appropriate nutritional support into the overall management of patients undergoing pancreatic resection...
July 17, 2018: Surgery
Waseem Majeed, Hood Thabit
Type 1 diabetes is characterised by destruction of pancreatic beta cells, leading to insulin deficiency and hyperglycaemia. The mainstay of treatment remains lifelong insulin therapy as a sustainable cure has as yet proven elusive. The burden of daily management of type 1 diabetes has contributed to suboptimal outcomes for people living with the condition. Innovative technological approaches have been shown to improve glycaemic and patient-related outcomes. Areas covered: We discuss recent advances in technologies in type 1 diabetes including closed-loop systems, also known as the 'artificial pancreas...
July 30, 2018: Expert Review of Medical Devices
Amar Mandalia, Erik-Jan Wamsteker, Matthew DiMagno
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS)...
2018: F1000Research
Claudia Della Corte, Simona Faraci, Fabio Majo, Vincenzina Lucidi, Douglas S Fishman, Valerio Nobili
Pancreatic disorders in children represent a growing health problem in pediatric patients. In the past two decades, several advances have been made in the knowledge of pediatric pancreatic disorders, with better understanding of different etiologies and clinical manifestations of these disorders. Moreover, many efforts have been made in pancreatology, aiming to define guidelines in the management of pancreatitis in children, initially based on the available information in adults. A multidisciplinary and multicenter approach is necessary to better determine pancreatic disease pathways and treatment options in children...
June 27, 2018: Digestive and Liver Disease
Teresa Macarulla, Alfredo Carrato, Rafael Díaz, Adelaida García, Berta Laquente, Javier Sastre, Rafael Álvarez, Andres Muñoz, Manuel Hidalgo
Data regarding management of frail patients with pancreatic ductal adenocarcinoma practice is currently very scarce. Randomized clinical trials usually exclude these subgroup of patients and the majority of the publications only consider chronological age and ECOG performance status for their classification. Therefore, the current available data do not reflect daily clinical practice. Only data from a phase two study (FRAGANCE study), designed to select a tolerable dose-schedule of nab-placitaxel + gemcitabine (Phase oneNCT02382263) and to evaluate the efficacy of the selected regimen (Phase two) in patients with ECOG-2 and previously untreated advanced PDAC, are currently available...
July 10, 2018: Journal of Geriatric Oncology
C Frère, B Bournet, I Benzidia, M Jamelot, P Debourdeau, A Hij, H Rafii-Elayoubi, L Buscail, D Farge
Pancreatic cancer (PC) is a devastating malignancy with an overall 5-year survival of 8% for all stages combined. Most of the PC patients diagnosed have an advanced disease (40%) or metastatic stage (40%), which eliminates surgery as a potentially curative treatment. The disease course is often complicated by venous thromboembolism (VTE) events, which per se account for significant morbidity and mortality, with significantly worsen survival. PC is associated with the highest risk of VTE among all cancer patients...
July 2018: Journal de Médecine Vasculaire
Thomas D Canale, HyoKeun Cho, Winson Y Cheung
Given the significant morbidity burden associated with advanced pancreatic cancer (APC), its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Patients diagnosed with APC from 2008 to 2015 and received Gemcitabine (Gem), Gemcitabine plus nab-Paclitaxel (Gem/Nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed...
July 4, 2018: Medical Oncology
Lingaku Lee, Tetsuhide Ito, Robert T Jensen
Recently, there have been a number of advances in imaging pancreatic neuroendocrine tumors (panNETs), as well as other neuroendocrine tumors (NETs), which have had a profound effect on the management and treatment of these patients, but in some cases are also associated with controversies. Areas covered: These advances are the result of numerous studies attempting to better define the roles of both cross-sectional imaging, endoscopic ultrasound, with or without fine-needle aspiration, and molecular imaging in both sporadic and inherited panNET syndromes; the increased attempt to develop imaging parameters that correlate with tumor classification or have prognostic value; the rapidly increasing use of molecular imaging in these tumors and the attempt to develop imaging parameters that correlate with treatment/outcome results...
July 17, 2018: Expert Review of Anticancer Therapy
Shan S Wong, Thomas J George, Melyssa Godfrey, Jennifer Le, Deidre B Pereira
PURPOSE: The quality of life (QOL) experiences of patients with pancreatic cancer and their caregivers is poorly understood. Psychological distress is high, but few studies examine the factors associated with psychological distress. The purpose of this study is to gain a richer understanding of the factors associated with psychological distress from patient and caregiver perspectives. METHODS: Twenty participants (13 patients, 7 caregivers) completed group discussions on the experiences of living with pancreatic cancer...
June 29, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Rohit Rajendra Bhosale, Hosahalli Veerabhadrappa Gangadharappa, Devegowda Vishakante Gowda, Riyaz Ali Mahafez Ali Osmani, Rudra Vaghela, Parthasarathi Keshavarao Kulkarni, Koganti Venkata Sairam, Bannimath Gurupadayya
Pancreatic cancer (PC) is one of the most fatal solid tumors, resulting in more than 250,000 deaths per year globally. It is the eighth leading cause of death from cancer in men and women throughout the world and is now third leading cause of cancer-related deaths in the United States. In addition, the worldwide occurrence of PC ranges from 1 to 10 cases per 100,000 people, indicating a higher incidence in developed countries. Most patients with locally advanced or metastatic disease are not candidates for curative resection due to enormously poor prognosis...
2018: Critical Reviews in Therapeutic Drug Carrier Systems
Marta K Walczak-Galezewska, Damian Skrypnik, Monika Szulinska, Katarzyna Skrypnik, Pawel Bogdanski
RATIONALE: Acute calculous cholecystitis is a prevalent disease whose diagnosis and management still face significant debate. Although the overall incidence of gallstone disease is 18.8% in European women aged 30 to 69 years, there is little data and experience in managing acute calculous cholecystitis in populations over 80 years old. The incidence of acute cholecystitis among the elderly is probably increasing. For the reason, we here highlight the advantages and disadvantage of various treatment and management opens based on a 96-year-old patient...
June 2018: Medicine (Baltimore)
Denis M Nyaga, Mark H Vickers, Craig Jefferies, Jo K Perry, Justin M O'Sullivan
Type 1 diabetes mellitus (T1D) is a complex autoimmune disorder characterised by loss of the insulin-producing pancreatic beta cells in genetically predisposed individuals, ultimately resulting in insulin deficiency and hyperglycaemia. T1D is most common among children and young adults, and the incidence is on the rise across the world. The aetiology of T1D is hypothesized to involve genetic and environmental factors that result in the T-cell mediated destruction of pancreatic beta cells. There is a strong genetic risk to T1D; with genome-wide association studies (GWAS) identifying over 60 susceptibility regions within the human genome which are marked by single nucleotide polymorphisms (SNPs)...
June 18, 2018: Molecular and Cellular Endocrinology
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