Neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma: The need for patient-centered research

Table 1 Selected comparative effectiveness studies of neoadjuvant therapy vs upfront surgery for pancreatic ductal adenocarcinoma

Ref.	Setting	Neoadjuvant type	Neoadjuvant therapy		Upfront surgery		Comments
			Sample size	Overall survival	Sample size	Overall survival
Population-based analyses
Mokdad et al[9], 2016	NCDB	Mixed	2005	26 mo	6015	21 mo	NT: ↓LN, ↓R1/R2 margins
Retrospective institutional analyses
Michelakos et al[46], 2019	United States	Chemo	110	38 mo	155	21 mo
Sugimoto et al[47], 2019	United States	Mixed	911	23 mo1	911	19 mo1	Resected patients: 29 mo vs 21 mo
Meta-analyses of retrospective studies
Versteijne et al[10], 2018	N/A	Mixed	17381	19 mo1	17461	15 mo1	NT: ↓resected rate, ↑R0 rate, ↓LN
Prospective randomized trials
Casadei et al[44], 2015	Italy	CRT	181	22 mo1	201	19 mo1	Did not complete accrual
Golcher et al[43], 2015	Germany	CRT	331	17 mo1	331	14 mo1	Did not complete accrual
Jang et al[14], 2018	South Korea	CRT	271	21 mo1	231	12 mo1	Terminated early (improved survival in NT group)
Van Tienhoven et al[13], 2018	Netherlands	CRT	1191	17 mo1	1271	13 mo1	Presented in abstract only
							Resected patients: 30 mo vs 17 mo
Unno et al[15], 2019	Japan	Chemo	1821	37 mo1	180	27 mo1	Presented in abstract only

¹Intention-to-treat. NCDB: National Cancer Database; LN: Lymph node positivity; NT: Neoadjuvant therapy; CRT: Chemoradiation therapy.

Table 2 Proposed goals of future patient-centered research on neoadjuvant therapy for pancreatic ductal adenocarcinoma

Patient preferences

What are patient perceptions and opinions regarding NT?

What are the barriers and facilitators to NT?

What sources of information inform decision making for NT?

The patient experience

How does shared decision making occur regarding NT?

How do patients perceive communication, coordination, and the health care experience during NT?

What resources are needed by patients undergoing NT?

Patient-reported outcomes (PROs)

Are PROs for pancreatic cancer similar or unique during NT?

How is patient quality of life affected by NT?

Survivorship

Does receipt of NT influence survivorship during and following treatment?

Do patients experience decisional regret/satisfaction?

NT: Neoadjuvant therapy.