4.6 Review

Neoadjuvant Therapy is Essential for Resectable Pancreatic Cancer

Journal

CURRENT MEDICINAL CHEMISTRY
Volume 26, Issue 40, Pages 7196-7211

Publisher

BENTHAM SCIENCE PUBL LTD
DOI: 10.2174/0929867325666180413101722

Keywords

Resectable pancreatic cancer; neoadjuvant therapy; neoadjuvant chemotherapy regimen; radiation to neoadjuvant chemotherapy; pancreatic ductal adenocarcinoma; novel therapy

Funding

  1. National Natural Science Foundation of China [81402397, 81472670, 81402398, 81172005]
  2. National Natural Science Foundation of Shanghai [14ZR1407600]
  3. Yang-Fan Plan for Young Scientists of Shanghai [14YF1401100]

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Background: Awareness of the benefits of neoadjuvant therapy is increasing, but its use as an initial therapeutic option for patients with resectable pancreatic cancer remains controversial, especially for those patients without high-risk prognostic features. Even for patients with high-risk features who are candidates to receive neoadjuvant therapy, no standard regimen exists. Methods: In this review, we examined available data on the neoadjuvant therapy in patients with resectable pancreatic cancer, including prospective studies, retrospective studies, and ongoing clinical trials, by searching PubMed/MEDLINE, ClinicalTrials.gov, Web of Science, and Cochrane Library. The characteristics and results of screened studies were described. Results: Retrospective and prospective studies with reported results and ongoing randomized studies were included. For patients with resectable pancreatic cancer, neoadjuvant therapy provides benefits such as increased survival, decreased risk of comorbidities and mortality, and improved cost-effectiveness due to an increased completion rate of multimodal treatment. Highly active regimens such as FOLFIRINOX (folinic acid, fluorouracil, irinotecan, and oxaliplatin) or gemcitabine plus nab-paclitaxel are considered acceptable therapeutic regimens. Additionally, platinum-containing regimens other than FOLFIRINOX are acceptable for selected patients. Other therapies, such as chemoradiation treatment, immtmo-oncology agents, and targeted therapies are being explored and the results are highly anticipated. Conclusion: This review highlights the benefits of neoadjuvant therapy for resectable pancreatic cancer. Some regimens are currently acceptable, but need more evidence from well-designed clinical trials or should be used after being carefully examined by a multidisciplinary team.

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