Pancreatic cancer (PDAC) is an aggressive and chemoresistant disease, representing the fourth cause of
cancer related deaths in western countries. Majority of patients have unresectable, locally advanced or metastatic disease at time of diagnosis and the 5-year survival rate in these conditions is extremely low. For more than a decade
gemcitabine has been the cornerstone of metastatic PDAC treatment, although survival benefit was very poor. PDAC cells are surrounded by an intense desmoplastic reaction that may create a barrier to the drugs penetration within the
tumor. Recently PDAC stroma has been addressed as a potential therapeutic target. Nano
albumin bound (
Nab)-paclitaxel is an innovative molecule depleting
tumor stroma, through interaction between
albumin and secreted
protein acidic and rich in
cysteine. Addition of
nab-paclitaxel to
gemcitabine has showed activity and efficacy in metastatic PDAC first-line treatment improving survival and overall response rate vs
gemcitabine alone in the MPACT phase III study. This combination represents one of the standards of care in advanced PDAC
therapy and is suitable to a broader spectrum of patients compared to other schedules.
Nab-paclitaxel is under investigation as a backbone of
chemotherapy in novel combinations with target agents or
immunotherapy in locally advanced or metastatic PDAC. In this article, we provide an updated and critical overview about the role of
nab-paclitaxel in PDAC treatment based on the latest advances in preclinical and clinical research. Furthermore, we focus on the use of
nab-paclitaxel within the context of metastatic PDAC treatment landscape and we discuss about future implications in the light of current clinical ongoing trials.