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Neoadjuvant therapy of pancreatic cancer – future standard in treatment?
03/2020 MUDr. Vladimír Frýba
More than 80 % of patients with pancreatic cancer are diagnosed in locally advanced or metastatic disease not amenable to potentially curative surgical resection. In patients with resectable tumor, resection followed by adjuvant chemotherapy is currently the standard of treatment. Adjuvant systemic therapy improves the prognosis of patients after curative resection. Up to a half of patients, however, cannot profit from adjuvant therapy due to postoperative complications, comorbidities or early metastases development. Neoadjuvant therapy has become the standard in majority of gastrointestinal malignancies (esophageal, gastric, rectal cancer). In recent years, it has emerged as an alternative treatment especially for patients with borderline resectable and resectable pancreatic cancer. However, randomized controlled trials of neoadjuvant treatment compared with upfront surgery are lacking. Results of recent meta-analyses suggest positive effect of neoadjuvant treatment and indicate better tolerance compared to adjuvant therapy, increased R0 resection rates and improved overall survival. Nevertheless, this positive effect as well as optimal type of neoadjuvant chemotherapy or chemoradiotherapy has to be elucidated in larger randomized trials.
ENTIRE ARTICLE
More than 80 % of patients with pancreatic cancer are diagnosed in locally advanced or metastatic disease not amenable to potentially curative surgical resection. In patients with resectable tumor, resection followed by adjuvant chemotherapy is currently the standard of treatment. Adjuvant systemic therapy improves the prognosis of patients after curative resection. Up to a half of patients, however, cannot profit from adjuvant therapy due to postoperative complications, comorbidities or early metastases development. Neoadjuvant therapy has become the standard in majority of gastrointestinal malignancies (esophageal, gastric, rectal cancer). In recent years, it has emerged as an alternative treatment especially for patients with borderline resectable and resectable pancreatic cancer. However, randomized controlled trials of neoadjuvant treatment compared with upfront surgery are lacking. Results of recent meta-analyses suggest positive effect of neoadjuvant treatment and indicate better tolerance compared to adjuvant therapy, increased R0 resection rates and improved overall survival. Nevertheless, this positive effect as well as optimal type of neoadjuvant chemotherapy or chemoradiotherapy has to be elucidated in larger randomized trials.