Pancreatic cancer has an unfavorable prognosis with a reduced possibility of long-term
survival. The only treatment with curative potential is surgery, but it is only possible in
15-20% of cases.
There are patients with clear criteria for surgical entry, others at the limit of the
possibility of surgery, and patients with such advanced disease (either locally or with
metastasis) that surgery is not indicated.
The objective of neoadjuvant chemotherapy treatment (received before surgery) is to reduce
the tumor before surgery and reduce the risk of subsequent metastases and local recurrences,
in borderline tumors or those resectable with high-risk criteria.
The FOLFIRINOX scheme, composed of 5-fluorouracil / folinic acid, oxaliplatin and irinotecan,
is recommended as neoadjuvant treatment, but the response is still low. This study will use a
modified FOLFIRINOX (NALIRINOX) regimen with a form of irinotecan attached to liposomes that
allows greater action on tumor cells.
Mutations in the KRAS gene are associated with a greater growth capacity of tumor cells and
are present in 90% of pancreatic cancers in advanced stages. They would be less frequent in
earlier phases but little is known about the impact that chemotherapy treatment and
subsequent surgery could have on the increase or decrease of these mutations, as well as
their implication. The follow-up of these mutations with repeated pancreatic biopsies is not
viable, but it can be monitored by simple blood samples in which the genetic material of the
tumor can be analyzed.