A Paradigm Shifts: Neoadjuvant Therapy for Clearly Resectable Pancreatic Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Neoadjuvant therapy is standard for borderline resectable and locally advanced pancreatic cancer.
• Debate exists regarding its utility in clearly resectable pancreatic cancer.
• Past trials comparing neoadjuvant therapy to upfront surgery faced challenges like poor accrual and underpowering.

Purpose of the Study:

• To review the rationale, considerations, and evidence for neoadjuvant therapy in clearly resectable pancreatic cancer.
• To discuss the shift towards neoadjuvant therapy, particularly with FOLFIRINOX.
• To highlight ongoing trials expected to provide more definitive recommendations.

Main Methods:

• Review of existing randomized controlled trials and meta-analyses.
• Analysis of survival data comparing different neoadjuvant regimens (gemcitabine vs. FOLFIRINOX).
• Discussion of clinical trial limitations and future research directions.

Main Results:

• Meta-analyses suggest neoadjuvant therapy is an acceptable standard for resectable pancreatic cancer.
• Neoadjuvant FOLFIRINOX shows superior survival compared to gemcitabine in patients who tolerate it.
• FOLFIRINOX utilization may be driving a paradigm shift towards neoadjuvant approaches.

Conclusions:

• Neoadjuvant therapy is a viable option for clearly resectable pancreatic cancer, supported by meta-analyses.
• FOLFIRINOX represents an advancement over gemcitabine, improving patient survival.
• Ongoing trials will further clarify the role and optimal use of neoadjuvant FOLFIRINOX.