Dr. Simeone on Selecting Patients With Pancreatic Cancer for Neoadjuvant Therapy

Diane M. Simeone, MD, Laura and Issac Perlmutter Professor of Surgery in the Department of Surgery; professor in the Department of Pathology; associate director of Translational Research at Perlmutter Cancer Center; and director of the Pancreatic Cancer Center of NYU Langone Health, explains which patients with pancreatic cancer should receive neoadjuvant therapy.

When considering which patients with locally-confined pancreatic cancer should receive neoadjuvant therapy, one must look at 3 categories: resectable, borderline, and locally advanced and unresectable categories, says Simeone.

For the resectable category, it is not in the guidelines that patients should receive neoadjuvant therapy, says Simeone. The standard of care is for patients to receive a high-quality, thin-slice CT scan for proper staging. If a tumor is determined to be resectable, then the patient can be offered a a surgical resection, explains Simeone. However, surgery alone is not the only tool used to treat those patients. The standard of care dictates that following recovery from surgery, which usually ranges from 4 to 6 weeks, patients should start adjuvant chemotherapy to help minimize the risk of disease recurrence, says Simeone.

Occasionally, up-front chemotherapy may be considered for some patients have resectable disease. For example, patients with larger tumors or tumors with a high level of CA 19-9 may be appropriate candidates for neoadjuvant chemotherapy, concludes Simeone.