Neoadjuvant therapy for pancreatic cancer

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Pancreatic ductal adenocarcinoma (PDAC) is best treated with surgery and chemotherapy, but most patients experience relapse due to micrometastatic disease.
• Neoadjuvant therapy is under investigation for resectable PDAC, with potential benefits for overall survival (OS).

Purpose of the Study:

• To review current treatment strategies for various clinical stages of PDAC.
• To discuss developments for optimizing multimodality therapy sequencing based on clinical and molecular features.

Main Methods:

• Review of current treatment strategies for localized and resectable pancreatic ductal adenocarcinoma.
• Discussion of neoadjuvant chemotherapy, adjuvant chemotherapy, and induction chemotherapy roles.
• Integration of clinical and molecular features for treatment optimization.

Main Results:

• Adjuvant chemotherapy is standard for resectable PDAC, while neoadjuvant chemotherapy may improve OS in borderline-resectable cases.
• Approximately 20% of unresectable non-metastatic PDAC patients may become resectable after induction chemotherapy, improving OS.
• Understanding distinct molecular and biological responses is crucial for optimizing treatment sequencing and improving OS.

Conclusions:

• Optimizing PDAC treatment requires integrating clinical and molecular insights to sequence multimodality therapies effectively.
• Neoadjuvant approaches may enhance survival outcomes in specific PDAC patient groups.
• Further research into therapy responses is essential for improving overall survival in PDAC.