Neoadjuvant Treatment for Resectable and Borderline Resectable Pancreatic Cancer: Chemotherapy or Chemoradiotherapy?

Abstract

Worldwide, there is a shifting paradigm from immediate surgery with adjuvant treatment to a neoadjuvant approach for patients with resectable or borderline resectable pancreatic cancer (RPC or BRPC). Comparison of neoadjuvant and adjuvant studies is extremely difficult because of a great difference in patient selection. The evidence from randomized studies shows that overall survival by intention-to-treat improves after neoadjuvant gemcitabine-based chemoradiotherapy or chemotherapy (various regimens), as compared to immediate surgery followed by adjuvant chemotherapy. Radiotherapy appears to play an important role in mediating locoregional effects. Yet, since more effective chemotherapy regimens are currently available, in particular FOLFIRINOX and Gemcitabine/Nab-paclitaxel, these chemotherapy regimens should be investigated in future randomized trials combined with (stereotactic) radiotherapy to further improve outcomes of RPC and BRPC.

CT Imaging Assessment of Pancreatic Adenocarcinoma Resectability after Neoadjuvant Therapy: Current Status and Perspective on the Use of Radiomics

“…While the comparison between neoadjuvant and adjuvant therapies is challenging due to the different patient populations that receive these therapies, recent systematic reviews and meta-analyses underscore the benefits of neoadjuvant therapy over adjuvant therapy, including improved overall survival, higher R0 resection rates, and fewer pathological lymph nodes [23][24][25]. Further, with the literature suggesting an increasing shift towards adopting a neoadjuvant approach, numerous ongoing trials are examining the effectiveness of different neoadjuvant chemotherapy approaches, such as neoadjuvant therapy involving FOLFIRINOX, neoadjuvant therapy involving gemcitabine/nab-paclitaxel, and neoadjuvant therapy combining chemotherapy and radiation therapy [26]. Promising outcomes from neoadjuvant therapy involving chemotherapy indicate that chemotherapy should be an integral component of the neoadjuvant strategy.…”

“…Given the various neoadjuvant strategies, molecular profiling at diagnosis and the evaluation of the immune environment are emerging as potential tools to personalize neoadjuvant strategies. Encouragingly, combining neoadjuvant therapy with immunotherapy has shown promise to improve patient outcomes, particularly in the context of localized disease [26].…”

The emerging role of pyroptosis in pediatric cancers: from mechanism to therapy

“…Chemotherapy is a diverse and rapidly progressing field [ 164 , 165 ]. While most researches explicitly cast attention to adult diseases, considerable efforts are being made to bring these therapies into the pediatric cancers.…”

Reply to W. Attaallah, A. Jain et al, and P. Mroczkowski et al

“…We recently published a discussion on the subject, with the suggestion that future neoadjuvant studies should not only involve modern multiagent chemotherapy but also should investigate the role of radiotherapy. 15 To answer their question regarding radiotherapy and lymph nodes, suspicious pathological lymph nodes were identified by a multiphase computed tomography scan of the abdomen, including contrast phase axial scans, required within 4 weeks before random assignment. Lymph nodes were suspicious if the short axis was larger than 10 mm, and these suspicious lymph nodes reported at the diagnostic computed tomography scan were included in the clinical target volume of radiotherapy.…”

“…We recently published a discussion on the subject, with the suggestion that future neoadjuvant studies should not only involve modern multiagent chemotherapy but also should investigate the role of radiotherapy. 15…”