Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?
Pancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the additi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/17/4396 |
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| author | Shelize Khakoo Angelica Petrillo Massimiliano Salati Abdul Muhith Jessica Evangelista Silvia Seghezzi Fausto Petrelli Gianluca Tomasello Michele Ghidini |
| author_facet | Shelize Khakoo Angelica Petrillo Massimiliano Salati Abdul Muhith Jessica Evangelista Silvia Seghezzi Fausto Petrelli Gianluca Tomasello Michele Ghidini |
| author_sort | Shelize Khakoo |
| collection | DOAJ |
| description | Pancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the addition of adjuvant chemotherapy representing an established standard of care for improving outcomes. Despite resection followed by adjuvant chemotherapy, at best, 3-year survival reaches 63.4%. Post-operative complications and poor performance mean that around 50% of the patients do not commence adjuvant chemotherapy, and a significant proportion do not complete the intended treatment course. These factors, along with the advantages of early treatment of micrometastatic disease, the ability to downstage tumors, and the increase in R0 resection rates, have increased interest in neo-adjuvant treatment strategies. Here we review biomarkers for early diagnosis of PDAC and patient selection for a neo-adjuvant approach. We also review the current evidence for different chemotherapy regimens in this setting, as well as the role of chemoradiotherapy and immunotherapy, and we discuss ongoing trials. |
| first_indexed | 2024-03-10T08:15:01Z |
| format | Article |
| id | doaj.art-c8546fb98cfc4dbe815e3e0aaa1a0015 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T08:15:01Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-c8546fb98cfc4dbe815e3e0aaa1a00152023-11-22T10:26:48ZengMDPI AGCancers2072-66942021-08-011317439610.3390/cancers13174396Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?Shelize Khakoo0Angelica Petrillo1Massimiliano Salati2Abdul Muhith3Jessica Evangelista4Silvia Seghezzi5Fausto Petrelli6Gianluca Tomasello7Michele Ghidini8Department of Medicine, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UKDivision of Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80131 Naples, ItalyDepartment of Oncology, University Hospital of Modena and Reggio Emilia, 41125 Modena, ItalyDepartment of Medicine, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UKDepartment of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, ItalyNuclear Medicine Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyOncology Unit, Medical Sciences Department, ASST Bergamo Ovest, 24047 Treviglio, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyPancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the addition of adjuvant chemotherapy representing an established standard of care for improving outcomes. Despite resection followed by adjuvant chemotherapy, at best, 3-year survival reaches 63.4%. Post-operative complications and poor performance mean that around 50% of the patients do not commence adjuvant chemotherapy, and a significant proportion do not complete the intended treatment course. These factors, along with the advantages of early treatment of micrometastatic disease, the ability to downstage tumors, and the increase in R0 resection rates, have increased interest in neo-adjuvant treatment strategies. Here we review biomarkers for early diagnosis of PDAC and patient selection for a neo-adjuvant approach. We also review the current evidence for different chemotherapy regimens in this setting, as well as the role of chemoradiotherapy and immunotherapy, and we discuss ongoing trials.https://www.mdpi.com/2072-6694/13/17/4396pancreatic ductal adenocarcinomaneo-adjuvant chemotherapyradiotherapyimmunotherapybiomarkersresectability |
| spellingShingle | Shelize Khakoo Angelica Petrillo Massimiliano Salati Abdul Muhith Jessica Evangelista Silvia Seghezzi Fausto Petrelli Gianluca Tomasello Michele Ghidini Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? Cancers pancreatic ductal adenocarcinoma neo-adjuvant chemotherapy radiotherapy immunotherapy biomarkers resectability |
| title | Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? |
| title_full | Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? |
| title_fullStr | Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? |
| title_full_unstemmed | Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? |
| title_short | Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome? |
| title_sort | neoadjuvant treatment for pancreatic adenocarcinoma a false promise or an opportunity to improve outcome |
| topic | pancreatic ductal adenocarcinoma neo-adjuvant chemotherapy radiotherapy immunotherapy biomarkers resectability |
| url | https://www.mdpi.com/2072-6694/13/17/4396 |
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