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Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

Medical Oncology Department, Institut de Cancérologie de Lorraine, CEDEX, 54519 Vandœuvre-lès-Nancy, France
Faculté de Médecine, Université de Lorraine, 54000 Nancy, France
Digestive Surgery Department, Rouen University Hospital, 1 rue de Germont, CEDEX, 76031 Rouen, France
Medical Oncology Department, Gustave Roussy, 39 rue Camille-Desmoulins, CEDEX, 94805 Villejuif, France
Université Paris Saclay, FCS Campus, 91190 Saint-Aubin, France
Author to whom correspondence should be addressed.
Academic Editor: Casper H.J. van Eijck
Cancers 2021, 13(18), 4724;
Received: 1 September 2021 / Revised: 15 September 2021 / Accepted: 15 September 2021 / Published: 21 September 2021
(This article belongs to the Special Issue Combination and Innovative Therapies for Pancreatic Cancer)
Only 10–20% of patients with newly diagnosed resectable pancreatic adenocarcinoma have potentially resectable disease. Upfront surgery is the gold standard, but it is rarely curative. After surgical extirpation of tumors, up to 80% of patients will develop cancer recurrence, and the initial relapse is metastatic in 50–70% of these patients. Adjuvant chemotherapy offers the best strategy to date to improve overall survival but faces real challenges; some patients will experience rapid disease progression within 3 months of surgery and patients who do not receive all planned cycles of chemotherapy have unfavourable oncological outcomes. The neoadjuvant approach is therefore logical but requires further investigation. This approach shows favourable trends regarding disease-free survival and overall survival but, in the absence of rigorous published phase III trials, is not validated to date. Here, we intend to provide a comprehensive analysis of the literature to provide direction for future studies.
Complete surgical resection is the cornerstone of curative therapy for resectable pancreatic adenocarcinoma. Upfront surgery is the gold standard, but it is rarely curative. Neoadjuvant treatment is a logical option, as it may overcome some of the limitations of adjuvant therapy and has already shown some encouraging results. The main concern regarding neoadjuvant therapy is the risk of disease progression during chemotherapy, meaning the opportunity to undergo the intended curative surgery is missed. We reviewed all recent literature in the following areas: major surveys, retrospective studies, meta-analyses, and randomized trials. We then selected the ongoing trials that we believe are of interest in this field and report here the results of a comprehensive review of the literature. Meta-analyses and randomized trials suggest that neoadjuvant treatment has a positive effect. However, no study to date can be considered practice changing. We considered design, endpoints, inclusion criteria and results of available randomized trials. Neoadjuvant treatment appears to be at least a feasible strategy for patients with resectable pancreatic cancer. View Full-Text
Keywords: chemoradiotherapy; neoadjuvant chemotherapy; FOLFIRINOX; gemcitabine; nab-paclitaxel; pancreatic cancer; surgery chemoradiotherapy; neoadjuvant chemotherapy; FOLFIRINOX; gemcitabine; nab-paclitaxel; pancreatic cancer; surgery
MDPI and ACS Style

Lambert, A.; Schwarz, L.; Ducreux, M.; Conroy, T. Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer. Cancers 2021, 13, 4724.

AMA Style

Lambert A, Schwarz L, Ducreux M, Conroy T. Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer. Cancers. 2021; 13(18):4724.

Chicago/Turabian Style

Lambert, Aurélien, Lilian Schwarz, Michel Ducreux, and Thierry Conroy. 2021. "Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer" Cancers 13, no. 18: 4724.

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