Adjuvant Therapy for Pancreatic Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 1443

Special Issue Editor


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Guest Editor
Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
Interests: cancer metabolism; signaling pathways; oncogenes; tumor suppressors; targeted therapies; genetic alterations; tumor microenvironment; biomarkers

Special Issue Information

Dear Colleagues,

Pancreatic cancer is one of the deadliest cancers with a dismal prognosis. Surgical resection combined with adjuvant chemotherapy is a common treatment option for resectable tumors. Multiple randomized clinical trials have shown that tumor resection followed by adjuvant chemotherapies enables the overall and progression-free survival of pancreatic cancer patients.  However, the increased rate of metastases leads to ineffective therapies. So, there is an urgent need for better approaches to target this metastatic disease. Currently, ongoing research in pancreatic cancer is exploring personalized therapies including combined adjuvant options by evaluating novel therapeutic targets and the use of genetic and other biomarkers. In addition, there has been tremendous progress towards the advancement of adjuvant chemotherapy protocols, which are evidence-based, to extend long-term survival benefits.

So far, mFOLFIRINOX (modified fluorouracil/irinotecan/oxaliplatin regimen) is regarded as the most effective systemic treatment option as an adjuvant therapy for selected as well as healthy subjects. In contrast, gemcitabine or GEMCAP (gemcitabine plus capecitabine) therapies are suggested for elderly patients or those with ECOG PS 2 (Eastern Co-operative Oncology Group Performance Status 2). Another approach worth investigating would be the response of immune checkpoint inhibitors (ICIs) in rare MSI-H (high microsatellite instability) PDAC (pancreatic ductal adenocarcinoma) patients.

The currently employed radiological tests are ineffective for identifying micro-metastatic disease, which indicates the requirement of biomarkers for the early detection of metastatic features in PDAC patients. Furthermore, the effect of adjuvant radiation therapy leading to improved outcomes of PDAC patients is debatable, owing to the scarcity of data that can validate the techniques and dosage used for radiotherapy. This Special Issue will highlight the current treatment options in pancreatic cancer, the progress demonstrated by new strategies, future prospects for improving targeted therapies and effective neoadjuvant therapies that offer improved survival benefits to patients with this extremely complex and heterogeneous disease.

Dr. Sonam Kumari
Guest Editor

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Keywords

  • chemotherapy
  • pancreatic resections
  • overall survival
  • gemcitabine
  • pancreatic ductal adenocarcinoma

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Published Papers (1 paper)

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Review

28 pages, 1428 KiB  
Review
Immune-Based Strategies for Pancreatic Cancer in the Adjuvant Setting
by Kai-Li Liang and Nilofer S. Azad
Cancers 2025, 17(7), 1246; https://doi.org/10.3390/cancers17071246 - 7 Apr 2025
Viewed by 765
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related mortality in the United States, with poor overall survival across all stages. Less than 20% of patients are eligible for curative surgical resection at diagnosis, and despite adjuvant chemotherapy, most will experience [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related mortality in the United States, with poor overall survival across all stages. Less than 20% of patients are eligible for curative surgical resection at diagnosis, and despite adjuvant chemotherapy, most will experience disease recurrence within two years. The incorporation of immune-based strategies in the adjuvant setting remains an area of intense investigation with unrealized promise. It offers the potential of providing durable disease control for micro-metastatic disease following curative intent surgery and enabling personalized treatments based on mutational neoantigen profiles derived from resected specimens. However, most of these attempts have failed to demonstrate significant clinical success, likely due to the immunosuppressive tumor microenvironment (TME) and individual genetic heterogeneity. Despite these challenges, immune-based strategies, such as therapeutic vaccines targeted towards neoantigens, have demonstrated promise via immune activation and induction of T-cell tumor infiltration. In this review, we will highlight the foundational lessons learned from previous clinical trials of adjuvant immunotherapy, discussing the knowledge gained from analyses of trials with disappointing results. In addition, we will discuss how these data have been incorporated to design new agents and study concepts that are proving to be exciting in more recent trials, such as shared antigen vaccines and combination therapy with immune-checkpoint inhibitors and chemotherapy. This review will evaluate novel approaches in ongoing and future clinical studies and provide insight into how these immune-based strategies might evolve to address the unique challenges for treatment of PDAC in the adjuvant setting. Full article
(This article belongs to the Special Issue Adjuvant Therapy for Pancreatic Cancer)
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