Advances in neoadjuvant therapy for pancreatic cancer: Current trends and future directions

Table 1 Neoadjuvant therapy in resectable pancreatic cancer

Ref.	Type of study	Year	Treated with radiotherapy	Total (n)	Stage of disease	Treatment regimen	Resection rate (%)	R0 resection rate (%)	Median OS (months)	Other outcome measure	Median DFS (months)
Ahmad et al[64]	Clinical trial	2020	No	55	RPC	mFOLFIRINOX	87	85	22.4	2-year OS rate: 41.60%	10.9
			No	47	RPC	Gemcitabine/nab-paclitaxel	77	85	23.6	48.80%	14.2
Motoi et al[65]	Clinical trial	2019	No	182	RPC	Gemcitabine + S1	NR	NR	36.7	NR	NR
			No	180	RPC	Upfront surgery	NR	NR	26.6	NR	NR
Versteijne et al[66]	Clinical trial	2020	Yes	65	RPC	Gemcitabine + radiotherapy	68	66	14.6	NR	9.2
			No	68	RPC	Upfront surgery	79	59	15.6	NR	9.3
Golcher et al[67]	Clinical trial	2015	Yes	33	RPC	Gemcitabine + cisplatin + radiotherapy	58	89	17.4	NR	NR
			No	33	RPC	Upfront surgery	70	70	14.4	NR	NR
Cucchetti et al[68]	Clinical Trial	2022	Yes	182	RPC	Gemcitabine + S1	NR	NR	36.7	NR	NR
Heinrich et al[69]	Clinical Trial	2019	Yes	102	RPC, BRPC, LAPC	Gemcitabine + radiotherapy	79	70	26.8	Improved resectability and surgical outcomes	12.1
Fujii et al[70]	Observational study	2017	Yes	40	RPC	5-FU + oteracil + gimeracil + S-1 + radiotherapy	92	97	24.9	NR	NR
			No	233	RPC	Upfront surgery	88	70	23.5	NR	NR
			No	56	RPC	Upfront surgery	87.5	56.5	NR	NR	NR
Casadei et al[71]	Randomized controlled trial	2015	Yes	18	RPC	Gemcitabine + radiotherapy	61.1	38.9	22.4	NR	NR
			No	20	RPC	Upfront surgery	75	25	19.5	NR	NR
Tzeng et al[72]	Retrospective study	2014	Yes	115	RPC	Gemcitabine and cisplatin + radiotherapy	83	89.5	28	NR	NR
			No	52	RPC	Upfront surgery	92.3	81.3	25.3	NR	NR
Ielpo et al[73]	Retrospective study	2017	Yes	19	RPC	Gemcitabine and nab-paclitaxel + radiotherapy	78.9	NR	22.1	NR	21
			No	17	RPC	Upfront surgery	100	NR	24.8	NR	14
Hoffman[74]	Review article	2010	No	N/A	RPC	FOLFIRINOX, gemcitabine-based therapies	NR	NR	NR	Enhanced R0 resection and downstaging in advanced cases	NR
Gillen et al[18]	Systematic review	2010	No	720	RPC	Multiple regimens	68.5	73	25.3	Improved tumor response and resection rates	NR

Table 1 provides a detailed summary of clinical trials and studies evaluating the efficacy of various neoadjuvant therapy (NAT) regimens in patients with resectable pancreatic cancer (RPC). The table includes data on study type, references, treatment regimens, resection rates, margin-negative (R0) resection rates (indicating margin-negative resection), median overall survival, and disease-free survival, where available. This provides a comprehensive view of the benefits and challenges associated with various neoadjuvant regimens in improving surgical outcomes. These metrics highlight the outcomes of different approaches, including chemotherapy, chemoradiation, and combinations of targeted agents. By presenting these key parameters, Table 1 underscores the significant improvements in resectability and survival outcomes achieved through NAT, compared with upfront surgery. Notably, regimens such as modified fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine-based therapies demonstrate the highest R0 resection rates, affirming the pivotal role of NAT in enhancing surgical outcomes. The table serves as a valuable resource for understanding the therapeutic potential and challenges associated with various NAT protocols in the management of RPC. RPC: Resectable pancreatic cancer; R0: Margin-negative resection; OS: Overall survival; DFS: Disease-free survival; mFOLFIRINOX: Modified fluorouracil, leucovorin, irinotecan, and oxaliplatin; 5-FU: 5-fluorouracil; N/A: Not applicable; NR: Not report; BRPC: Borderline resectable pancreatic cancer; LAPC: Locally advanced pancreatic cancer.