Published online Jun 15, 2023. doi: 10.4251/wjgo.v15.i6.911
Peer-review started: December 28, 2022
First decision: February 16, 2023
Revised: February 17, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: June 15, 2023
Processing time: 168 Days and 9.4 Hours
Pancreatic adenocarcinoma (PDAC) is one of the most common and lethal human cancers worldwide. Surgery followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC, although only approximately 20% of the patients have resectable tumors when diagnosed. Neoadjuvant chemotherapy (NACT) is recommended for borderline resectable pancreatic cancer. Several studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology, as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable PDAC. In such challenging cases, new potential tools, such as ct-DNA and molecular targeted therapy, are emerging as novel therapeutic options that may improve old paradigms. This review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.
Core Tip: Pancreatic adenocarcinoma (PDAC) is one of the most common and lethal human cancers worldwide; yet patients diagnosed with it still have a poor prognosis. Multimodal therapy is one of the most promising treatment options that increase the overall survival. Neoadjuvant chemotherapy (NACT) is recommended for treating borderline resectable PDAC. While recent studies have tried to explore the role of NACT in treating resectable and locally advanced PDAC, novel therapeutic modalities, such as ct-DNA and molecular targeted therapy, may guide both treatment and monitoring during the disease course to improve prognosis.