Neoadjuvant Therapy for Locally Advanced Pancreatic Cancer

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Approximately one-third of newly diagnosed patients with pancreatic cancer have locally advanced disease. Approximately 15% to 20% of patients are diagnosed with borderline resectable disease, suggest a high potential for future surgery. For these patients, neoadjuvant therapy can be administered to downgrade the tumor to a point where it can be resected, suggests Philip A. Philip, MD, PhD. Whether to use this strategy depends largely on the patient’s fitness level and the goals of therapy.

While locally advanced patients are now commonly treated with upfront systemic therapy using FOLFIRINOX or nab-paclitaxel, there are no randomized data for either regimen in this setting. A series of clinical trials are currently being conducted. At this point, utilization of these treatment strategies is based largely on institutional experience with both regimens.

Typically, a patient treated with neoadjuvant therapy is reevaluated every two or three months. Patients with stable disease or better can receive consolidation radiotherapy and concurrent capecitabine. Radiotherapy, explains Eileen O’Reilly, MD, may improve tumor regression by targeting tumor vasculature. For patients with progressive disease, the time to progression determines whether they will resume the first-line regimen or switch to another combination. In many situations, patients with borderline resectable pancreatic cancer do not end up having surgery following systemic therapy, notes O’Reilly.