Wu ST, Zhu L, Feng XL, Yang L, Chen GW, Jiang Y, Huang TF, Wang HY, Li F. Advances in neoadjuvant therapy for pancreatic cancer: Current trends and future directions. World J Clin Oncol 2025; 16(6): 105849 [DOI: 10.5306/wjco.v16.i6.105849]
Corresponding Author of This Article
Fang Li, MD, PhD, Department of General Surgery, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New District, Chongqing 401147, China. leef123456@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Jun 24, 2025; 16(6): 105849 Published online Jun 24, 2025. doi: 10.5306/wjco.v16.i6.105849
Advances in neoadjuvant therapy for pancreatic cancer: Current trends and future directions
Shi-Tao Wu, Li Zhu, Xiao-Ling Feng, Li Yang, Guo-Wei Chen, Yan Jiang, Ting-Fang Huang, Hao-Yu Wang, Fang Li
Shi-Tao Wu, Li Zhu, Xiao-Ling Feng, Li Yang, Guo-Wei Chen, Yan Jiang, Ting-Fang Huang, Hao-Yu Wang, Fang Li, Department of General Surgery, Chongqing General Hospital, Chongqing 401147, China
Author contributions: Wu ST conceptualized the review, conducted the literature search, and drafted the initial manuscript; Zhu L contributed to the critical analysis of the literature and provided significant revisions to the manuscript; Feng XL assisted in the data interpretation and helped in organizing the structure of the review; Chen GW contributed to the analysis of key methodologies and assisted in refining the discussion sections; Jiang Y provided input on statistical considerations and assisted in reviewing relevant studies; Huang TF contributed to editing and improving the clarity of the manuscript; Wang HY contributed to the sections on emerging technologies and future directions and provided expert input on the clinical implications; Li F, as the corresponding author, oversaw the entire project, coordinated contributions from all authors, and finalized the manuscript for submission; All authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report 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: Fang Li, MD, PhD, Department of General Surgery, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New District, Chongqing 401147, China. leef123456@163.com
Received: February 8, 2025 Revised: March 26, 2025 Accepted: May 16, 2025 Published online: June 24, 2025 Processing time: 132 Days and 7.9 Hours
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most challenging malignancies, with poor survival rates due to late-stage diagnosis and limited treatment options. Neoadjuvant therapy (NAT), which involves chemotherapy or chemoradiation prior to surgical resection, has emerged as a promising approach to improve resectability and overall survival (OS). The integration of advanced imaging techniques and biomarkers for evaluating the response to NAT is crucial for optimizing therapeutic strategies and surgical outcomes. However, challenges related to the heterogeneity of treatment protocols and the need for predictive biomarkers remain, highlighting the necessity for further clinical trials. The aim is to evaluate the impact of NAT on surgical outcomes and predictive markers in pancreatic cancer. A comprehensive review of the literature was conducted to evaluate the impact of NAT on surgical resectability, survival outcomes, and the role of imaging and biomarkers in assessing therapeutic response. Studies examining the efficacy of NAT in patients with PDAC, the predictive value of serum biomarkers such as carbohydrate antigen 19-9 (CA 19-9), and the utility of advanced imaging modalities such as positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) were included. NAT has demonstrated significant benefits in downstaging tumors, increasing margin-negative (R0) resection rates, and reducing micrometastatic disease. The use of serum CA 19-9 Levels as a biomarker for response evaluation and imaging modalities such as FDG-PET/CT and magnetic resonance imaging has proven valuable in predicting therapeutic efficacy and guiding surgical planning. Studies have shown that significant reductions in CA 19-9 Levels and favorable metabolic responses on imaging are associated with higher R0 resection rates and longer survival. Furthermore, the integration of multimodal imaging and biomarker assessment has enabled better stratification of patients and more personalized treatment strategies. NAT significantly improves surgical outcomes and survival in patients with resectable and borderline resectable PDAC. Advanced imaging techniques and biomarkers such as CA 19-9 play pivotal roles in evaluating the response to therapy and guiding surgical decision-making. Future research should focus on addressing variability in treatment strategies and developing more reliable predictive biomarkers.
Core Tip: This review highlights the transformative role of neoadjuvant therapy in managing pancreatic ductal adenocarcinoma (PDAC), emphasizing its benefits in improving resectability, enhancing margin-negative resection (R0) rates, and addressing micrometastatic disease. The integration of advanced imaging modalities, such as positron emission tomography/computed tomography with 18F-fluorodeoxyglucose, and biomarkers like carbohydrate antigen 19-9 enables personalized treatment strategies and better surgical planning. By synthesizing recent evidence, the study underscores the critical importance of multimodal approaches, tailored regimens, and emerging therapies in optimizing outcomes for patients with resectable and borderline resectable PDAC.
