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Review
. 2020 Nov;405(7):879-887.
doi: 10.1007/s00423-020-01946-4. Epub 2020 Aug 10.

Neoadjuvant therapy in pancreatic cancer: what is the true oncological benefit?

Lei Ren  1   2 , Carmen Mota Reyes  1 , Helmut Friess  1   3   4 , Ihsan Ekin Demir  5   6   7   8
Affiliations
Review

Neoadjuvant therapy in pancreatic cancer: what is the true oncological benefit?

Lei Ren et al. Langenbecks Arch Surg. 2020 Nov.

Abstract

Background: Neoadjuvant therapies (neoTx) have revolutionized the treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer (PCa) by significantly increasing the rate of R0 resections, which remains the only curative strategy for these patients. However, there is still room for improvement of neoTx in PCa.

Purpose: Here, we aimed to critically analyze the benefits of neoTx in LA and BR PCa and its potential use on patients with resectable PCa. We also explored the feasibility of arterial resection (AR) to increase surgical radicality and the incorporation of immunotherapy to optimize neoadjuvant approaches in PCa.

Conclusion: For early stage, i.e., resectable, PCa, there is not enough scientific evidence for routinely recommending neoTx. For LA and BR PCa, optimization of neoadjuvant therapy necessitates more sophisticated complex surgical resections, machine learning and radiomic approaches, integration of immunotherapy due to the high antigen load, standardized histopathological assessment, and improved multidisciplinary communication.

Keywords: Arterial resection; Immunotherapy; Neoadjuvant therapy; Pancreatic cancer.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The evolving arms of a pleiotropic neoadjuvant therapy (neoTx) for locally advanced pancreatic cancer (PCa). We envision that the survival benefit through neoTx in locally advanced or borderline resectable PCa can be further improved via (1) more sophisticated approaches for complex surgical resections, (2) increased integration of radiomic approaches to staging and restaging after neoTx, (3) testing of immunotherapy in the neoadjuvant setting due to the relatively higher antigen load of the tumor, (4) worldwide standardization of the histopathological assessment, and (5) improved communication between all disciplines
See this image and copyright information in PMC

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