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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2023; 29(35): 5094-5103
Published online Sep 21, 2023. doi: 10.3748/wjg.v29.i35.5094
Developments and challenges in neoadjuvant therapy for locally advanced pancreatic cancer
Bo Zhou, Shi-Ran Zhang, Geng Chen, Ping Chen
Bo Zhou, Shi-Ran Zhang, Geng Chen, Ping Chen, Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
Author contributions: Chen P contributed to the concept, design, and drafting of the article, and approved the final revision; Zhou B drafted the article; Zhang SR and Chen G revised the manuscript critically for intellectual content; all authors approved the version to be published.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Chen, MD, PhD, Professor, Surgeon, Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China. chenpingsyd@126.com
Received: June 10, 2023
Peer-review started: June 10, 2023
First decision: July 10, 2023
Revised: July 19, 2023
Accepted: August 31, 2023
Article in press: August 31, 2023
Published online: September 21, 2023
Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains a significant public health challenge and is currently the fourth leading cause of cancer-related mortality in developed countries. Despite advances in cancer treatment, the 5-year survival rate for patients with PDAC remains less than 5%. In recent years, neoadjuvant therapy (NAT) has emerged as a promising treatment option for many cancer types, including locally advanced PDAC, with the potential to improve patient outcomes. To analyze the role of NAT in the setting of locally advanced PDAC over the past decade, a systematic literature search was conducted using PubMed and Web of Science. The results suggest that NAT may reduce the local mass size, promote tumor downstaging, and increase the likelihood of resection. These findings are supported by the latest evidence-based medical literature and the clinical experience of our center. Despite the potential benefits of NAT, there are still challenges that need to be addressed. One such challenge is the lack of consensus on the optimal timing and duration of NAT. Improved criteria for patient selection are needed to further identify PDAC patients likely to respond to NAT. In conclusion, NAT has emerged as a promising treatment option for locally advanced PDAC. However, further research is needed to optimize its use and to better understand the role of NAT in the management of this challenging disease. With continued advances in cancer treatment, there is hope of improving the outcomes of patients with PDAC in the future.

Keywords: Neoadjuvant therapy, Pancreatic ductal adenocarcinoma, Locally advanced pancreatic cancer, Chemoradiotherapy, Immunotherapy, Vaccine therapy

Core Tip: In recent years, neoadjuvant therapy (NAT) has emerged as a promising treatment option for many cancer types, including locally advanced pancreatic ductal adenocarcinoma, with the potential to improve patient outcomes. To analyze the role of NAT in the setting of locally advanced pancreatic ductal adenocarcinoma over the past decade, a systematic literature search was conducted using PubMed and Web of Science. Despite the potential benefits of NAT, there are still challenges that need to be addressed. Additionally, there is a need for better patient selection criteria to identify those who are most likely to benefit from this approach.