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Resectable Pancreatic Cancer: Neoadjuvant and Adjuvant Therapy

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Pancreatic Cancer

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Abstract

Pancreatic cancer is a highly lethal malignancy with rising incidence. For the 10–20% of patients that present with resectable disease, upfront surgery is the standard of care. Despite optimal surgery, recurrence rates are high. Apparently, most patients have systemic disease at diagnosis. In an effort to improve outcomes, adjuvant therapy has been developed over the last decades, and its use is supported by level 1 evidence. The main problem with adjuvant therapy is that up to half of patients are unable to receive it as result of complications from surgery with clinical deterioration. Neoadjuvant therapy (i.e., before surgery) is increasingly investigated with the hypothesis that outcomes will improve if all patients receive systemic chemotherapy. Published randomized controlled trials found superior outcomes with neoadjuvant therapy, but used mostly single-agent gemcitabine. The ongoing PREOPANC-3 and ALLIANCE A021806 trials compare adjuvant with perioperative (i.e., both neoadjuvant and adjuvant) mFOLFIRINOX in patients with resectable pancreatic cancer.

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  1. Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Jacob L. van Dam & Bas Groot Koerkamp

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  1. GI Medical Oncology, The University of Texas MD Anderson Canc, Houston, TX, USA

    Shubham Pant

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van Dam, J.L., Groot Koerkamp, B. (2023). Resectable Pancreatic Cancer: Neoadjuvant and Adjuvant Therapy. In: Pant, S. (eds) Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-031-38623-7_1

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