Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 1-8
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.1
Neoadjuvant treatment for resectable pancreatic adenocarcinoma
John Wong, Naveenraj L Solomon, Chung-Tsen Hsueh
John Wong, Chung-Tsen Hsueh, Division of Medical Oncology and Hematology, Department of Internal Medicine, Loma Linda University, Loma Linda, CA 92354, United States
Naveenraj L Solomon, Department of Surgery, Loma Linda University, Loma Linda, CA 92354, United States
Author contributions: Wong J, Solomon NL and Hsueh CT conceived the issues which formed the content of the manuscript and wrote the manuscript.
Conflict-of-interest statement: The author has no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chung-Tsen Hsueh, MD, PhD, Division of Medical Oncology and Hematology, Department of Internal Medicine, Loma Linda University, 11175 Campus Street, CSP 11015, Loma Linda, CA 92354, United States. chsueh@llu.edu
Telephone: +1-909-5584910 Fax: +1-909-5580219
Received: June 28, 2015
Peer-review started: July 11, 2015
First decision: August 16, 2015
Revised: November 6, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: February 10, 2016
Abstract

Pancreatic adenocarcinoma is the fourth leading cause of cancer mortality in the United States in both men and women, with a 5-year survival rate of less than 5%. Surgical resection remains the only curative treatment, but most patients develop systemic recurrence within 2 years of surgery. Adjuvant treatment with chemotherapy or chemoradiotherapy has been shown to improve overall survival, but the delivery of treatment remains problematic with up to 50% of patients not receiving postoperative treatment. Neoadjuvant therapy can provide benefits of eradication of micrometastasis and improved delivery of intended treatment. We have reviewed the findings from completed neoadjuvant clinical trials, and discussed the ongoing studies. Combinational cytotoxic chemotherapy such as fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel, active in the metastatic setting, are being studied in the neoadjuvant setting. In addition, novel targeted agents such as inhibitor of immune checkpoint are incorporated with cytotoxic chemotherapy in early-phase clinical trial. Furthermore we have explored the utility of biomarkers which can personalize treatment and select patients for target-driven therapy to improve treatment outcome. The treatment of resectable pancreatic adenocarcinoma requires multidisciplinary approach and novel strategies including innovative trials to make progress.

Keywords: Pancreatic cancer, Resectable pancreatic adenocarcinoma, Neoadjuvant treatment, Biomarkers, Chemotherapy, Surgery

Core tip: The treatment of resectable pancreatic adenocarcinoma requires multidisciplinary approach and novel strategies including innovative trials to make progress. Data from completed neoadjuvant clinical trials are reviewed, and important ongoing studies are presented. Biomarkers for patient selection and personalized medicine are discussed.