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

Lei Ren, Carmen Mota Reyes, Helmut Friess, Ihsan Ekin Demir

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations

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.

Original languageEnglish
Pages (from-to)879-887
Number of pages9
JournalLangenbeck's Archives of Surgery
Volume405
Issue number7
DOIs
StatePublished - 1 Nov 2020
Externally publishedYes

Keywords

  • Arterial resection
  • Immunotherapy
  • Neoadjuvant therapy
  • Pancreatic cancer

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