Neoadjuvant therapy for resectable pancreatic cancer: a narrative review

The use of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma remains controversial and limited. Therefore, this literature review aimed to assess the feasibility, safety, and efficacy of this treatment. A database search of peer-reviewed articles published in English between January 1990 and June 2021 in PubMed, MEDLINE, and the Web of Science was performed. Original articles, review articles, and meta-analyses relevant to the topic were selected. We found 2 to 4 cycles with FOLFIRINOX, gemcitabine plus nab-paclitaxel, gemcitabine plus S-1, or gemcitabine alone were the most acceptable treatments. Considering the risk of adverse events and cancer progression, NAT is considered safe and tolerable, with a comparable resection rate. Although NAT can result in moderate tumor responses and some extent of local control (improvement of complete resection rate and negative lymph node metastases), no obvious survival benefit is observed. To date, the survival benefits of NAT for resectable pancreatic ductal adenocarcinoma have been very limited. It is too early to say that NAT is the best treatment option for resectable pancreatic cancer.