Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist's Perspective

Abstract

Pancreatic cancer has traditionally been associated with a dismal prognosis, even in early stages of the disease. In recent years, the introduction of newer generation chemotherapy regimens in the adjuvant setting has improved the survival of patients treated with upfront resection. However, there are multiple theoretical advantages to deliver early systemic therapy in patients with localized pancreatic cancer. So far, the evidence supports the use of neoadjuvant therapy for patients with borderline resectable pancreatic cancer. The benefit of this treatment sequence for patients with resectable disease remains elusive. In this review, we summarize the data on adjuvant therapy for pancreatic cancer and describe which evidence backs the use of neoadjuvant therapy. Additionally, we address important issues faced in clinical practice when treating patients with localized pancreatic cancer.

Keywords: adjuvant; cancer; chemotherapy; neoadjuvant; pancreatic; radiotherapy.

Figure 1.

Staging and treatment algorithm for patients with localized pancreatic cancer.^@ High-risk features: large (>2–3 cm) tumors, positive lymph nodes (biopsy-proven or based on PET-CT), elevated CA 19-9 levels (≥500 UI/ml), celiac-type pain, significant weight loss (≥10% of body weight), or suspicious hepatic or pulmonary lesions.^# Unfit for upfront surgery: ECOG 2.^$ During neoadjuvant therapy, consider physical and nutritional rehabilitation.