Published online Jul 21, 2021. doi: 10.3748/wjg.v27.i27.4383
Peer-review started: January 28, 2021
First decision: March 29, 2021
Revised: April 12, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: July 21, 2021
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is best treated in a multidisciplinary fashion using surgery, chemotherapy, and radiation. Adjuvant chemotherapy has shown to have a significant survival benefit in patients with resected PDAC. However, up to 50% of patients fail to receive adjuvant chemotherapy due to postoperative complications, poor patient performance status or early disease progression. In order to ensure the delivery of chemotherapy, an alternative strategy is to administer systemic treatment prior to surgery. Precision oncology refers to the application of diverse strategies to target therapies specific to characteristics of a patient’s cancer. While traditionally emphasized in selecting targeted therapies based on molecular, genetic, and radiographic biomarkers for patients with metastatic disease, the neoadjuvant setting is a prime opportunity to utilize personalized approaches. In this article, we describe the current evidence for the use of neoadjuvant therapy (NT) and highlight unique opportunities for personalized care in patients with PDAC undergoing NT.
Core Tip: Neoadjuvant therapy (NT) is an increasingly utilized approach that maximizes the receipt of multimodality therapy, improves margin-negative resection rates, and potentially increases survival durations. In the era of personalized medicine, the neoadjuvant period can also be used to emphasize precision oncology. Already, current methods of anatomically staging, molecularly profiling, and monitoring response to therapy can be used to personalize neoadjuvant treatment for localized pancreatic ductal adenocarcinoma (PDAC). In this article, we describe the current evidence for the use of NT and highlight unique opportunities for personalized care in patients with PDAC undergoing NT.