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

Table 3 Neoadjuvant therapy in locally advanced 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)	Median DFS (months)
Murphy et al[88]	Clinical trial	2019	Yes	49	LAPC	FOLFIRINOX + losartan + radiotherapy	80.9	88.2	31.4	NR
Stein et al[89]	Clinical trial	2016	Yes	31	LAPC	mFOLFIRINOX + radiotherapy	41.9	100	26.6	17.8
Pross et al[90]	Clinical trial	2015	Yes	120	LAPC	Multiple regimens + radiotherapy	Improved R0 resection	NR	Improved survival	NR
Ou et al[91]	Clinical trial	2020	Yes	85	LAPC	Gemcitabine-based regimen + radiotherapy	77.1	84.5	30.1	12.2
Boone et al[92]	Retrospective study	2013	Yes	13	LAPC	FOLFIRINOX + radiotherapy	20	50	NR	NR
Sadot et al[93]	Retrospective study	2015	Yes	101	LAPC	FOLFIRINOX and gemcitabine + radiotherapy	30.7	51.6	25	NR
Wo et al[94]	Retrospective study	2018	Yes	74	LAPC	FOLFIRINOX and gemcitabine + radiotherapy	39.2	NR	18.1	14.9
Hackert et al[95]	Retrospective study	2016	Yes	575	LAPC	FOLFIRINOX + radiotherapy	60.8	NR	16	NR
			Yes	575	LAPC	Gemcitabine + radiotherapy	46.6	NR	16.5	NR
			Yes	575	LAPC	Other regimens	51.6	NR	14	NR
Marthey et al[96]	Observational study	2015	Yes	77	LAPC	FOLFIRINOX + radiotherapy	36.4	89.3	22	NR
Gillen et al[18]	Systematic review	2010	Yes	860	LAPC	Various chemoradiation regimens	Improved R0 resection	NR	Prolonged survival	NR
Hyung et al[97]	Narrative review	2022	Nr	N/A	LAPC, BRPC	Overview of neoadjuvant chemotherapy and chemoradiation approaches	NR	NR	NR	NR

To further illustrate the impact of neoadjuvant therapy (NAT) on locally advanced pancreatic cancer (LAPC), Table 3 provides a detailed overview of studies evaluating the efficacy of NAT in patients with LAPC. The table highlights a range of clinical trials, retrospective studies, observational studies, and reviews, focusing on treatment regimens, the use of radiotherapy, resection rates, margin-negative (R0) resection rates, median overall survival, and disease-free survival. The data underscore the transformative potential of NAT in LAPC, demonstrating its ability to convert unresectable tumors into resectable ones, improve R0 resection rates, and extend survival outcomes. Specific regimens, such as fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) combined with radiotherapy, are prominently featured for their superior performance in improving resectability and survival. The integration of innovative approaches, such as losartan with FOLFIRINOX, further highlights the emerging strategies to enhance tumor response. Table 3 serves as a critical reference for understanding the clinical impact of various NAT protocols and emphasizes the role of multimodal approaches in addressing the challenges of LAPC management. LAPC: Locally advanced pancreatic cancer; BRPC: Borderline resectable pancreatic cancer; NAT: Neoadjuvant therapy; R0: Margin-negative resection; OS: Overall survival; DFS: Disease-free survival; FOLFIRINOX: Fluorouracil, leucovorin, irinotecan, and oxaliplatin; mFOLFIRINOX: Modified fluorouracil, leucovorin, irinotecan, and oxaliplatin; NR: Not reported.