Maeve A. Lowery, MD

All improvements in outcomes for patients with metastatic pancreatic adenocarcinoma have occurred with the use of cytotoxic agents, which will probably remain the mainstay of treatment for advanced pancreatic adenocarcinoma.

The case of recurrent pancreatic cancer presented in this issue of ONCOLOGY by Dr. Dasari and colleagues illustrates the significant challenges faced by both medical and surgical oncologists in the management of pancreatic adenocarcinoma. This case describes an all-too-common clinical scenario: A thorough preoperative assessment indicating resectable disease, but with the initial medical oncology assessment revealing overt metastatic disease. The development of distant metastases in the short interval between pre-operative and post-operative staging reflects the aggressive underlying biology associated with a subset of patients with this malignancy. New insight into the genetic evolution of pancreas adenocarcinoma from Yachida and colleagues suggests that the latent period between initial development of pancreas adenocarcinoma and development of metastases is measured in years, however detection of the diagnosis at an early stage remains an ongoing challenge for clinicians.[1]