Neoadjuvant treatment in resectable pancreatic cancer: Why is upfront surgery so hard to be beaten?

doi:10.5306/wjco.v16.i9.108955

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Oncol. Sep 24, 2025; 16(9): 108955
Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.108955

Table 2 Randomized Clinical trials of neoadjuvant treatment for resectable pancreatic adenocarcinoma

Ref.	Year	Trial design	Age (range), years	Regimen	Intervention	n	Median OS (95%CI), months	OS HR (95%CI)	Median DFS (95%CI), months	DFS HR (95%CI)	R0 rates,%
Casadei et al[22]; Di Marco et al[23]	2015	Ph2	71.5 (51-78)	Neoadjuvant	GEM + RDT -> surgery -> GEM	18	24.3 (8.0-40.6)	P = 0.17	18.03 (2.58-33.48)	P = 0.24	38.9
Casadei et al[22]; Di Marco et al[23]	2015	Ph2	67.5 (48-79)	Adjuvant	Surgery -> GEM	20	21.1 (8.3-33.9)	P = 0.17	8.53 (4.47-12.59)	P = 0.24	25
Golcher et al[24]	2015	Ph2	62.5 (33-76)	Neoadjuvant	GEM, CDDP + RDT -> surgery > GEM	33	17.4	P = 0.96	—	—	52
Golcher et al[24]	2015	Ph2	65.1 (46-73)	Adjuvant	Surgery -> GEM	33	14.4	P = 0.96	—	—	48
Reni et al[25]	2018	Ph2	64 (39-75)	Neoadjuvant	PEXG -> Surgery -> PEXG	32	38.2 (27.3-49.1)	—	16.9 (3.7-28.7)	—	63
			68 (49-75)	Adjuvant	Surgery -> PEXG	30	26.4 (15.8-26.7)		12.4 (5.4-19.4)		37
			65 (37-74)	Adjuvant	Surgery > GEM	26	20.4 (14.6-25.8)		4.7 (0.9-8.9)		27
Satoi[26]	2019	Ph3	Not presented	Neoadjuvant	GEM + S1 -> surgery- > S1	182	36.7 (28.6-43.3)	P = 0.01	—	—	—
Satoi[26]	2019	Ph3	Not presented	Adjuvant	Surgery -> S1	180	26.6 (21-31.3)	P = 0.01	—	—	—
Versteijne et al[7]	2022	Ph3	66 (59-71)	Neoadjuvant	GEM + RDT -> surgery -> GEM	65	14.6 (NS)	P = 0.83	9.2	0.88 (0.60-1.28), P = 0.52	66
Versteijne et al[7]	2022	Ph3	67 (60-73)	Adjuvant	Surgery -> GEM	68	15.6 (NS)	P = 0.83	9.3	0.88 (0.60-1.28), P = 0.52	59
Labori et al[20]	2024	Ph2	68 (60-72)	Neoadjuvant	FFX-> Surgery-> Gem, Cap or FFX	77	25.1 (17.2-34.9)	P = 0.05	11.9 (9.3-15.7)	P = 0.22	56
Labori et al[20]	2024	Ph2	66 (57-72)	Adjuvant	Surgery -> Gem, Cap or FFX	63	38.5 (27.6-NR)	P = 0.05	16.2 (10.8-21)	P = 0.22	39
PREOPANC-2[23]	2023	Ph3	66 (NS)	Neoadjuvant	FFX-> surgery	185	21.9 (17.7-27)	P = 0.28	NS	-	61
PREOPANC-2[23]	2023	Ph3	68 (NS)	Neoadjuvant	GEM+RDT-> Surgery-> GEM	184	21.3 (16.8-25.5)	P = 0.28	NS	-	67
Seufferlein et al[18]	2023	Ph2	Not presented	Neoadjuvant	GEM + NAB-PACL > surgery	59	25.2 (NS)	HR: 1.26 (0.80-1.97)	11.5	1.31 (0.86-1.99)	87.8
Seufferlein et al[18]	2023	Ph2	Not presented	Adjuvant	Surgery > GEM + NAB-PACL	59	16.7 (NS)	HR: 1.26 (0.80-1.97)	5.9	1.31 (0.86-1.99)	67.4

Ph3: Phase 3; Ph2: Phase 2; Gem: Gemcitabine; 5-FU: Fluorouracil; RDT: Radiotherapy; mFFX: Modified FOLFIRINOX; NR: Not-reached; Nab-Pac: Nab-paclitaxel; NS: No specified; CDDP: Cisplatin; PEXG: Cisplatin, epirubicin, capecitabine, gemcitabine.

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Citation: Uson Junior PLS, Kadakia KC, Araujo RLC. Neoadjuvant treatment in resectable pancreatic cancer: Why is upfront surgery so hard to be beaten? World J Clin Oncol 2025; 16(9): 108955
URL: https://www.wjgnet.com/2218-4333/full/v16/i9/108955.htm
DOI: https://dx.doi.org/10.5306/wjco.v16.i9.108955

Uson Junior PLS, Kadakia KC, Araujo RLC. Neoadjuvant treatment in resectable pancreatic cancer: Why is upfront surgery so hard to be beaten? World J Clin Oncol 2025; 16(9): 108955 [PMID: 41024839 DOI: 10.5306/wjco.v16.i9.108955]

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