Advances and challenges of neoadjuvant therapy in pancreatic cancer

Abstract

Pancreatic cancer has been becoming the second cause of cancer death in the western world, and its disease burden has increased. Neoadjuvant therapy is one of the current research hotspots in the field of pancreatic cancer, aiming to improve the surgical rate and prognosis of pancreatic cancer. Based on the latest evidence, this review discussed neoadjuvant therapy in pancreatic cancer from the following three aspects: patient selection, protocols selection of neoadjuvant therapy, and treatment response evaluation and resectability prediction. A big controversy existed on the indications of neoadjuvant treatment, but it was agreed that any patient who is likely to achieve R0 resection due to neoadjuvant therapy should be the targeted population. A variety of chemotherapy regimens were tried for neoadjuvant therapy in pancreatic cancer, and FOLFIRINOX and Nab-Paclitaxel plus Gemcitabine are two preferred regimens at present. It was challenging to evaluate treatment response and predict resectability after neoadjuvant therapy, although imaging by CT is widely used. Based on new findings of the remarkable performance of several chemotherapy regimens with or without radiotherapy, the neoadjuvant indications of pancreatic cancer have extended in recent years. However, it is still a challenge to assess the neoadjuvant treatment response and determine the timing of surgery.

Role of Immunohistochemistry in Suspected Pancreatic Ductal Adenocarcinoma

“…Our study showed that the expression of the immunohistochemical markers Maspin, IMP3, S100A, S100P, and TFFs is significantly different in PDAC, as compared with nonneoplastic pancreatic conditions, in accordance with previous studies. 11,[14][15][16]22 In the present study, we found that all markers were unreactive on nonneoplastic samples, while a variable reactivity was obtained in neoplastic ones. In the 3 samples in group 1, all immunohistochemical markers were negative, and the final diagnosis on the surgical sample was of chronic pancreatitis.…”

“…9,12,13 In addition, standard imaging techniques, including CT and MRI, can be inconclusive when attempting to distinguish the 2 types of lesions. 12,13 Recent studies reported the potential of neoadjuvant therapy to decrease the size of pancreatic tumors and make them more resectable, 14 thus improving the outcome. In this situation, a rapid and accurate diagnosis on FNAB of a pancreatic mass is crucial.…”

Pancreatic Cancer: Pathogenesis, Screening, Diagnosis, and Treatment

“…Tumor tissue acquisition pretreatment (via biopsy) and at surgery offers a unique opportunity to observe the intratumoral changes in the tumor and TME after various treatment regimens. 165,166 A recent analysis by Farren et al 167 that examined gene expression and spatial distribution of numerous immunologically relevant cells and proteins showed distinct differences in resected tumors from untreated pancreatic tumors vs tumors treated with neoadjuvant therapy. As a retrospective study, the relevance of these changes to patient outcome and response to further adjuvant therapy are not addressed; however, the results indicate further research in this area is needed.…”

The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy

“…NAT is now one of the most commonly used treatments for cancer and has a wide range of clinical applications in the areas of pancreatic cancer, breast cancer, gastric cancer, colorectal cancer, and cholangiocarcinoma (56)(57)(58)(59). To improve clinical prognosis and outcomes, NAT has also been introduced to the treatment of EC, especially for patients with locally advanced EC.…”