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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(04): 211-213
DOI: 10.4103/0971-5851.195731
REVIEW ARTICLE

Should every patient with pancreatic cancer receive perioperative/neoadjuvant therapy?

Ulrich Nitsche
Department of Surgery, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
,
Bo Kong
Department of Surgery, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
,
Alexander Balmert
Department of Surgery, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
,
Helmut Friess
Department of Surgery, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
,
Jörg Kleeff
Department of Surgery, University of Liverpool, Liverpool, UK
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Pancreatic ductal adenocarcinoma is a highly aggressive disease, and medical as well as surgical therapeutic options are limited. This article reviews stage dependent treatment options, with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally advanced patients. Neoadjuvant treatment can potentially increase the rate of complete tumor resection and may be more effective than adjuvant systemic therapy. Further, in the case of disease progression during or after neoadjuvant therapy, patients can be spared extensive surgery. Today, common therapeutic regimens include gemcitabine/nab-paclitaxel and FOLFIRINOX, as well as chemoradiation. However, because of the paucity of evidence from randomized trials, most guidelines do not recommend neoadjuvant therapy in resectable tumors, and for borderline or locally advanced tumors only within clinical trials. Importantly, every patient should be discussed in multidisciplinary tumor boards.

Keywords

Neoadjuvant - pancreatic cancer - pancreatic ductal adenocarcinoma - perioperative


Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr JM, Neoptolemos J, et al. Addressing the challenges of pancreatic cancer: Future directions for improving outcomes. Pancreatology 2015;15:8-18.
  • 2 Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: A systematic review and meta-analysis of response and resection percentages. PLoS Med 2010;7:e1000267.
  • 3 Nitsche U, Wenzel P, Siveke JT, Braren R, Holzapfel K, Schlitter AM, et al. Resectability after first-line FOLFIRINOX in initially unresectable locally advanced pancreatic cancer: A single-center experience. Ann Surg Oncol 2015;22 Suppl 3:1212-20.
  • 4 Fathi A, Christians KK, George B, Ritch PS, Erickson BA, Tolat P, et al. Neoadjuvant therapy for localized pancreatic cancer: Guiding principles. J Gastrointest Oncol 2015;6:418-29.
  • 5 Tempero MA, Malafa MP, Behrman SW, Benson AB 3rd, Casper ES, Chiorean EG, et al. Pancreatic adenocarcinoma, version 2. 2014: Featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2014;12:1083-93.
  • 6 Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013;369:1691-703.
  • 7 Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011;364:1817-25.
  • 8 Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2014;155:977-88.
  • 9 Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 2015;261:12-7.
  • 10 Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200-10.