Open AccessShould every patient with pancreatic cancer receive perioperative/neoadjuvant therapy?
Author(s) -
Ulrich Nitsche,
Bo Kong,
Alexander Balmert,
Helmut Friess,
Jörg Kleeff
Publication year - 2016
Publication title -
indian journal of medical and paediatric oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.229
H-Index - 22
eISSN - 0975-2129
pISSN - 0971-5851
DOI - 10.4103/0971-5851.195731
Subject(s) - medicine , folfirinox , neoadjuvant therapy , gemcitabine , pancreatic cancer , oncology , perioperative , adjuvant therapy , randomized controlled trial , stage (stratigraphy) , disease , systemic therapy , clinical trial , cancer , surgery , colorectal cancer , irinotecan , breast cancer , paleontology , biology
Pancreatic ductal adenocarcinoma is a highly aggressive disease, and medical as well as surgical therapeutic options are limited. This article reviews stage dependent treatment options, with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally advanced patients. Neoadjuvant treatment can potentially increase the rate of complete tumor resection and may be more effective than adjuvant systemic therapy. Further, in the case of disease progression during or after neoadjuvant therapy, patients can be spared extensive surgery. Today, common therapeutic regimens include gemcitabine/nab-paclitaxel and FOLFIRINOX, as well as chemoradiation. However, because of the paucity of evidence from randomized trials, most guidelines do not recommend neoadjuvant therapy in resectable tumors, and for borderline or locally advanced tumors only within clinical trials. Importantly, every patient should be discussed in multidisciplinary tumor boards.