Neoadjuvant therapy for pancreatic cancer.
Christoph SpringfeldCristina R FerroneMatthew H G KatzPhilip A PhilipTheodore S HongThilo HackertMarkus W BüchlerJohn P NeoptolemosPublished in: Nature reviews. Clinical oncology (2023)
Patients with localized pancreatic ductal adenocarcinoma (PDAC) are best treated with surgical resection of the primary tumour and systemic chemotherapy, which provides considerably longer overall survival (OS) durations than either modality alone. Regardless, most patients will have disease relapse owing to micrometastatic disease. Although currently a matter of some debate, considerable research interest has been focused on the role of neoadjuvant therapy for all forms of resectable PDAC. Whilst adjuvant combination chemotherapy remains the standard of care for patients with resectable PDAC, neoadjuvant chemotherapy seems to improve OS without necessarily increasing the resection rate in those with borderline-resectable disease. Furthermore, around 20% of patients with unresectable non-metastatic PDAC might undergo resection following 4-6 months of induction combination chemotherapy with or without radiotherapy, even in the absence of a clear radiological response, leading to improved OS outcomes in this group. Distinct molecular and biological responses to different types of therapies need to be better understood in order to enable the optimal sequencing of specific treatment modalities to further improve OS. In this Review, we describe current treatment strategies for the various clinical stages of PDAC and discuss developments that are likely to determine the optimal sequence of multimodality therapies by integrating the fundamental clinical and molecular features of the cancer.
Keyphrases
- locally advanced
- neoadjuvant chemotherapy
- rectal cancer
- squamous cell carcinoma
- radiation therapy
- sentinel lymph node
- end stage renal disease
- healthcare
- newly diagnosed
- small cell lung cancer
- early stage
- palliative care
- chronic kidney disease
- peritoneal dialysis
- prognostic factors
- quality improvement
- skeletal muscle
- free survival
- young adults
- single molecule
- lymph node metastasis
- insulin resistance
- pain management
- squamous cell
- combination therapy
- health insurance