Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?

Cancers

Abdul Muhith¹  Shelize Khakoo¹  Massimiliano Salati²  Jessica Evangelista³  Angelica Petrillo⁴  Gianluca Tomasello⁵  Michele Ghidini⁵  Silvia Seghezzi⁶  Fausto Petrelli⁷ 

[1] Department of Medicine, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK;Department of Oncology, University Hospital of Modena and Reggio Emilia, 41125 Modena, Italy;Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;Division of Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80131 Naples, Italy;Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;Nuclear Medicine Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy;Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, 24047 Treviglio, Italy;

关键词: pancreatic ductal adenocarcinoma;    neo-adjuvant chemotherapy;    radiotherapy;    immunotherapy;    biomarkers;    resectability;   

DOI  :  10.3390/cancers13174396

来源: DOAJ

【 摘 要 】

Pancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the addition of adjuvant chemotherapy representing an established standard of care for improving outcomes. Despite resection followed by adjuvant chemotherapy, at best, 3-year survival reaches 63.4%. Post-operative complications and poor performance mean that around 50% of the patients do not commence adjuvant chemotherapy, and a significant proportion do not complete the intended treatment course. These factors, along with the advantages of early treatment of micrometastatic disease, the ability to downstage tumors, and the increase in R0 resection rates, have increased interest in neo-adjuvant treatment strategies. Here we review biomarkers for early diagnosis of PDAC and patient selection for a neo-adjuvant approach. We also review the current evidence for different chemotherapy regimens in this setting, as well as the role of chemoradiotherapy and immunotherapy, and we discuss ongoing trials.

【 授权许可】

Unknown