ASO Author Reflections: Neoadjuvant Chemotherapy for Localized Pancreatic Ductal Adenocarcinoma—Predictors of Disease Progression and Performance Status Decline

Excerpt

The recognition of pancreatic adenocarcinoma (PDC) as a systemic disease at the time of diagnosis has led to substantial efforts toward optimizing multimodality treatment strategies. Surgical resection has been, and remains, the cornerstone of PDC treatment and crucial work has gone into the definition of surgical resectability.1,2 Consequently, a need arose to devise strategies that increase access to surgical therapy for patients presenting with localized disease that were not immediately resectable, often due to the involvement of mesenteric vasculatures. Neoadjuvant chemotherapy (NT) has gained significant momentum during the last decade on the premise of greater tolerability before surgical resection. Its most notable attributes include the capacity to downsize the tumor, leading to higher rates of R0 resection, and the potential to test the biological behavior of the tumor, thus allowing early identification of aggressive subtypes that would not benefit from surgical resection. Several retrospective studies and at least two large meta-analyses support the use of NT in the setting of localized PDC (i.e. borderline resectable and locally advanced).3,4 On the basis of these encouraging early results, few centers expanded the use of NT to immediately resectable lesions. However, with this good comes the bad and the ugly for some patients; namely, disease progression and performance status decline during treatment, which ultimately precludes surgical intervention. We reviewed our institutional experience with a cohort of localized PDC patients treated with NT, delving on factors associated with failure to reach planned surgical therapy. …