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World J Gastrointest Oncol. Dec 15, 2017; 9(12): 457-465
Published online Dec 15, 2017. doi: 10.4251/wjgo.v9.i12.457
Neoadjuvant therapy for resectable pancreatic cancer
Sheikh Hasibur Rahman, Robin Urquhart, Michele Molinari
Sheikh Hasibur Rahman, Robin Urquhart, Department of Surgery, Dalhousie University, Halifax B3H 2Y9, Nova Scotia, Canada
Michele Molinari, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Author contributions: Rahman SH participated in the concept, design and search of the scientific literature, extracted the data and wrote the manuscript including the tables; Urquhart R participated in the concept and design and participated in revising the manuscript; Molinari M formulated the research question, designed the literature search, supervised and co-authored the manuscript with Rahman SH.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michele Molinari, MD, MSc, Senior Scientist, Surgeon, Associate Professor, Department of Surgery, University of Pittsburgh Medical Center, 3459 Fifth Avenue, N758, Pittsburgh, PA 15213, United States. molinarim@upmc.edu
Telephone: +1-412-6475734 Fax: +1-412-6475736
Received: June 25, 2017
Peer-review started: June 27, 2017
First decision: August 7, 2017
Revised: August 24, 2017
Accepted: September 15, 2017
Article in press: September 15, 2017
Published online: December 15, 2017
Processing time: 171 Days and 2.8 Hours
Abstract

The use of neoadjuvant therapies has played a major role for borderline resectable and locally advanced pancreatic cancers (PCs). For this group of patients, preoperative chemotherapy or chemoradiation has increased the likelihood of surgery with negative resection margins and overall survival. On the other hand, for patients with resectable PC, the main rationale for neoadjuvant therapy is that the overall survival with current strategies is unsatisfactory. There is a consensus that we need new treatments to improve the overall survival and quality of life of patients with PC. However, without strong scientific evidence supporting the theoretical advantages of neoadjuvant therapies, these potential benefits might turn out not to be worth the risk of tumors progression while waiting for surgery. The focus of this paper is to provide the readers an overview of the most recent evidence on this subject.

Keywords: Pancreatic adenocarcinoma; Neoadjuvant chemotherapy; Neoadjuvant chemoradiation therapy; Meta-analysis; Decision analysis; Borderline resectable; Locally advanced; Randomized controlled trial; Phase I trial; Phase II trial; Phase III trial

Core tip: The use of neoadjuvant therapy for patients with resectable pancreatic cancer (PC) has been used by an increasing number of cancer centers around the world. The main rationale of using neoadjuvant therapies in resectable PC is the hope that patients’ likelihood of long-term overall survival will benefit from the chemo or chemoradiation therapy administered when their overall conditions allow them to tolerate the treatment. At this time, there is no phase III trial to support the use of neoadjuvant therapies in resectable PC. Without strong scientific evidence supporting the theoretical advantages of neoadjuvant therapies, these potential benefits might turn out not to be worth the risk of tumors progression while waiting for surgery.