Neoadjuvant therapy for pancreatic cancer

Surgical resection is necessary but generally insufficient as curative treatment for pancreatic cancer. Traditionally, postoperative (adjuvant) therapies have been utilized in an attempt to improve outcome, yet these efforts have met with extremely limited success. As preoperative (neoadjuvant) treatment strategies have evolved for the treatment of other malignancies, preoperative therapy for pancreatic cancer has been investigated by several groups over the past decade. At this time, no randomized trials comparing adjuvant and neoadjuvant therapies have been performed, nor have there been any large multicenter trials of neoadjuvant therapy for pancreatic cancer. In this manuscript, the rationale for neoadjuvant strategies are discussed in the context of the available data on both adjuvant and neoadjuvant therapy and clinical trials currently in development.