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Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions
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Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions

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

Deadline for manuscript submissions: 31 August 2026 | Viewed by 4425

Special Issue Editor

Dr. Daniela Cornelia Lazăr

E-Mail Website
Guest Editor
Department V of Internal Medicine I, Discipline of Internal Medicine IV, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
Interests: oncology; immunotherapy; angiogenesis; internal medicine; gastroenterology; cardio-renal-metabolic syndrome
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue, “Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions”, will explore the evolving landscape of neoadjuvant treatments for hepatopancreatobiliary cancers, including hepatocellular carcinoma, pancreatic cancer, and cholangiocarcinoma. Neoadjuvant therapy, encompassing chemotherapy, radiotherapy, immunotherapy, and targeted approaches, plays a critical role in improving surgical outcomes and survival rates in these challenging malignancies. For this Special Issue, we invite the submission of original research articles, reviews, and clinical studies that address current advancements, novel therapeutic strategies, and the molecular mechanisms underlying treatment responses. Contributions should focus on the latest clinical trials, treatment protocols, biomarkers for predicting efficacy, and emerging personalized treatment approaches. The goal is to provide a comprehensive update on both established and experimental therapies, highlighting future directions in neoadjuvant treatment in these cancers.

Dr. Daniela Cornelia Lazăr
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neoadjuvant therapy
  • hepatopancreatobiliary malignancies
  • hepatocellular carcinoma
  • pancreatic cancer
  • cholangiocarcinoma
  • chemotherapy
  • radiotherapy
  • immunotherapy
  • targeted therapies
  • personalized treatment

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Published Papers (3 papers)

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Research

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17 pages, 465 KB  
Article
The Role of a “Conservative” Resection Strategy After Neoadjuvant Treatment for Borderline/Locally Advanced PDAC with Arterial Involvement: A Single-Centre Retrospective Observational Study
by Roberta Vella, Elisa Bannone, Alessandro Giardino, Isabella Frigerio, Martina Guerra, Erica Pizzocaro, Laura Bignotto, Filippo Scopelliti, Paolo Regi, Camillo Aliberti, Guido Martignoni, Roberto Girelli, Marcello Lino, Paolo Pederzoli and Giovanni Butturini
Cancers 2026, 18(5), 830; https://doi.org/10.3390/cancers18050830 - 4 Mar 2026
Viewed by 609
Abstract
Background: Recent advances in multimodal therapies have increased the potential for resectability of borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). We herein describe the conservative resection strategy adopted at our institution and the oncological outcomes of patients with PDAC and arterial [...] Read more.
Background: Recent advances in multimodal therapies have increased the potential for resectability of borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). We herein describe the conservative resection strategy adopted at our institution and the oncological outcomes of patients with PDAC and arterial involvement. Methods: This retrospective single-centre study included patients diagnosed with PDAC and radiologic evidence of arterial involvement who underwent surgical exploration between January 2014 and June 2024. All patients received induction chemotherapy (±radiotherapy). Survival outcomes were analyzed using the Kaplan–Meier and Cox proportional hazards models. Logistic regression analyses were used to identify predictors of resectability and recurrence. Results: A total of 76 patients were included: 59 underwent pancreatic resection with arterial divestment (AD) in case of persistent arterial involvement and 17 were deemed unresectable at laparotomy. Neoadjuvant folfirinox was significantly associated with increased odds of resection (HR = 3.23, 95% CI: 1.59–9.90, p = 0.040). Median overall survival from diagnosis was 33 months (29–39) in resected patients and 26 months (16–29) in non-resected patients (p = 0.0176). Surgical resection and Ca 19,9 normalization after induction therapy were associated with reduced mortality risk (HR = 0.38, 95% CI: 0.19–0.75, p = 0.005 and HR = 0.56, 95% CI: 0.35–0.88, p = 0.014, respectively). Conclusions: Despite a limited sample size and retrospective nature, these findings highlight the value of multimodal strategies in managing PDAC with arterial involvement. AD represents a valuable technique associated with acceptable outcomes in selected patients. Future interventional prospective studies are needed to optimize patient selection and validate the prognostic role of extended surgical procedures. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions)
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14 pages, 1208 KB  
Article
Efficacy of Conversion Surgery for Initially Unresectable Biliary Tract Cancer That Has Responded to Down-Staging Chemotherapy
by Takashi Murakami, Ryusei Matsuyama, Yasuhiro Yabushita, Yuki Homma, Yu Sawada, Kentaro Miyake, Takafumi Kumamoto, Kazuhisa Takeda, Shin Maeda, Shoji Yamanaka and Itaru Endo
Cancers 2025, 17(5), 873; https://doi.org/10.3390/cancers17050873 - 3 Mar 2025
Cited by 2 | Viewed by 3091
Abstract
Background: Due to the limited efficacy of chemotherapy alone in the treatment of unresectable biliary tract cancer, we performed conversion surgery in patients with unresectable biliary tract cancer who responded to down-staging chemotherapy. Methods: Patients with unresectable biliary tract cancer who initiated chemotherapy [...] Read more.
Background: Due to the limited efficacy of chemotherapy alone in the treatment of unresectable biliary tract cancer, we performed conversion surgery in patients with unresectable biliary tract cancer who responded to down-staging chemotherapy. Methods: Patients with unresectable biliary tract cancer who initiated chemotherapy between 2007 and 2018 were included in this study. We evaluated the short- and long-term outcomes of patients with initially unresectable biliary tract cancer who underwent conversion surgery. Results: A total of 101 patients with unresectable biliary tract cancers treated with chemotherapy were eligible for the present study. A total of 20 patients eventually underwent conversion surgery; these patients had locally advanced disease in 6 cases, liver metastasis in 6 cases, para-aortic lymph node metastasis in 5 cases, and peritoneal dissemination in 3 cases. The mean operative time was 823 min, and the mean intraoperative blood loss was 1902 mL. Histological R0 resections were performed in 17 patients. Postoperative complications of Clavien–Dindo grade IIIa or higher occurred in 10 patients, with no surgery-associated deaths. The 5-year survival rate was significantly higher in patients who underwent conversion surgery (65.0%) than in those who did not (4.3%, p < 0.001). Conclusions: Conversion surgery for initially unresectable biliary tract cancer resulted in favorable overall survival and was safely performed despite its high surgical invasiveness. Conversion surgery for an initially unresectable biliary tract cancer is worth considering. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions)
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Review

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15 pages, 7010 KB  
Review
Integrating Advanced Endoscopic Techniques and Confocal Microscopy for Early Detection of Extrahepatic Cholangiocarcinoma
by Barbara Lattanzi, Francesco Covotta, Anna Crescenzi, Antonietta Lamazza, Francesco Maria Di Matteo, Domenico Alvaro and Vincenzo Cardinale
Cancers 2026, 18(9), 1334; https://doi.org/10.3390/cancers18091334 - 22 Apr 2026
Viewed by 254
Abstract
Extrahepatic cholangiocarcinoma (eCCA) is a highly aggressive malignancy arising from the biliary epithelium, with surgical resection representing the only potentially curative treatment. The predominant periductal infiltrating growth pattern, characterized by subepithelial tumor spread and desmoplastic stromal reaction, severely limits the diagnostic sensitivity of [...] Read more.
Extrahepatic cholangiocarcinoma (eCCA) is a highly aggressive malignancy arising from the biliary epithelium, with surgical resection representing the only potentially curative treatment. The predominant periductal infiltrating growth pattern, characterized by subepithelial tumor spread and desmoplastic stromal reaction, severely limits the diagnostic sensitivity of conventional endoscopic sampling techniques, which primarily assess the luminal mucosal surface. This review provides a histomorphology-oriented diagnostic framework for indeterminate extrahepatic biliary strictures, integrating advanced endoscopic technologies with emerging optical diagnostic approaches. ERCP combined with cholangioscopy demonstrates superior sensitivity for perihilar strictures, while EUS-guided tissue acquisition shows higher diagnostic yield in distal cholangiocarcinoma, also providing locoregional staging. Advanced EUS technologies—including elastography, contrast harmonic EUS, and Detective Flow Imaging—further improve characterization of indeterminate strictures by evaluating tissue stiffness, microvascular architecture, and periductal infiltration. Ex vivo fluorescence confocal laser microscopy (FCM) enables real-time microscopic evaluation of biopsy specimens, reducing diagnostic turnaround time and minimizing inadequate sampling. A location-adapted diagnostic algorithm integrating cross-sectional imaging, ERCP, cholangioscopy, and EUS is proposed. An integrated, biology-informed endoscopic approach tailored to tumor location and ductal wall involvement may significantly improve early eCCA detection and guide patient selection for curative treatment. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy in Hepatopancreatobiliary Malignancies: Current Trends and Future Directions)
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