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Pancreatic Cancer pp 1187-1202 | Cite as

Neoadjuvant Chemotherapy in Pancreatic Cancer

  • Theodoros Michelakos
  • Cristina R. Ferrone
Reference work entry

Abstract

More than 30% of pancreatic ductal adenocarcinoma (PDAC) patients present with borderline resectable (BR) or locally advanced (LA) disease. Historically, this patient population had a poor prognosis, with the majority not being offered an operation. Following the promising results of modern combination regimens such as FOLFIRINOX (5-FU, oxaliplatin and irinotecan) and gemcitabine plus nab-paclitaxel for patients with metastatic PDAC, these regimens have been utilized in patients with BR or LA disease to render them resectable. Indeed, neoadjuvant FOLFIRINOX increases resectability of LA PDAC up to 44%, with margin-negative resection rates and overall survival rates comparable to upfront resectable patients. Neoadjuvant chemotherapy also aids in obviating adjuvant therapy, which is frequently not initiated or completed due to the morbidity associated with pancreatic operations. Based on the encouraging results in locally advanced and borderline patients, neoadjuvant chemotherapy may also be of use in patients presenting with resectable disease. Neoadjuvant therapy may aid in screening patients with aggressive disease who progress on neoadjuvant therapy, and therefore may not benefit from an operation. Clinical trials currently underway will provide further information on the efficacy of modern neoadjuvant therapies for PDAC patients.

Keywords

Pancreatic ductal adenocarcinoma Neoadjuvant chemotherapy FOLFIRINOX Gemcitabine and nab-paclitaxel Locally advanced pancreatic adenocarcinoma Borderline resectable pancreatic adenocarcinoma 

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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