This 1.25-credit CME course provides a review and update of current practice on minimally invasive vs. open pancreaticoduodenectomy, including trends and outcomes in robotic and laparoscopic pancreaticoduodenectomy.

This 1-hour CME review article focuses on screening, multidisciplinary evaluation, and treatment of early esophageal adenocarcinoma.

The poor showing for immunotherapy in PDAC is likely a result of the cancer’s complex immunosuppressive tumor microenvironment, acting to insulate the tumor against an effective cytotoxic immune response. This review summarizes the mechanisms of immunosuppression within the PDAC tumor microenvironment and provides an up-to-date review of completed and ongoing clinical trials using various immunotherapy strategies.

ctDNA provides an intriguing, noninvasive means of evaluating solid organ malignancies—from early diagnosis to personalized treatment decisions to prognosis and estimating risk of recurrence.

The 18-month OS rates in this trial were: 66.7% for neoadjuvant mFOLFIRINOX 47.3% for neoadjuvant mFOLFIRINOX and hypofractionated radiotherapy 87.5% for mFOLFIRINOX followed by pancreatectomy 78.9% for mFOLFIRINOX plus radiotherapy followed by pancreatectomy The authors state these results “suggest that mFOLFIRINOX represents a reference neoadjuvant treatment regimen for borderline resectable pancreatic cancer; however, the role of radiotherapy in this setting remains undefined.”

This paring of PARP inhibitor and immune checkpoint inhibitor may be a viable non-cytotoxic maintenance therapy option for patients with platinum-sensitive pancreatic ductal adenocarcinoma. At a median follow-up of 23.0 months, combining the PARP inhibitor niraparib with the anti CTLA-4 antibody ipilimumab achieved a 6-month PFS rate of 59.6%, which was superior to the comparator — a clinically meaningful benchmark of 44%. The results were not the same when a PD-1 inhibitor (nivolumab) were used. That trial arm yielded a poorer 6-month PFS vs the benchmark.