Preoperative treatments in borderline resectable and locally advanced pancreatic cancer: Current evidence and new perspectives

Surgery is the only curative treatment for non-metastatic pancreatic adenocarcinoma, but less than 20 % of patients present a resectable disease at diagnosis. Treatment strategies and disease definition for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) vary in the different cancer centres. Preoperative chemotherapy (CT) is the standard of care for both BRPC and LAPC patients, however literature data are still controversial concerning the type, dose and duration of the different CT regimens, as well as regarding the integration of radiotherapy (RT) or chemoradiation (CRT) in the therapeutic algorithm. In this unsettled debate, we aimed at focusing on the therapeutic regimens currently in use and relative literature data, to report international trials comparing the available therapeutic options or explore the introduction of new pharmacological agents, and to analyse possible new scenarios in microenvironment evaluation before and after neoadjuvant therapies or in patients' selection at a molecular level.

Automated summary

Surgery is the main treatment for non-metastatic pancreatic adenocarcinoma, but few patients are eligible for surgery at diagnosis. There are different treatment strategies for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) among different cancer centers. Preoperative chemotherapy is standard for both BRPC and LAPC patients, but there is still controversy regarding the specific treatment regimens, including type, dose, and duration, as well as the integration of radiotherapy or chemoradiation in the treatment plan. This study aims to review the current therapeutic regimens and literature data, compare available treatment options, explore new pharmacological agents, and analyze potential advancements in evaluating the microenvironment and selecting patients at a molecular level.