Goals of Treatment Sequencing for Localized Pancreatic Cancer

Excerpt

There is now general consensus that pancreatic cancer is a systemic disease at the time of diagnosis, even among patients with apparent localized disease.1 This clinical observation was in fact appreciated many decades ago, when it became apparent that the vast majority of patients operated upon with curative intent experienced metachronous recurrence even when the operation went “perfectly.” However, despite improved clarity around the natural history of pancreatic adenocarcinoma, there remains debate on optimal treatment sequencing. The manuscript by Altman and colleagues in this issue of Annals of Surgical Oncology adds to the now robust body of literature demonstrating that patients who undergo surgery (first) for operable pancreatic cancer may never receive intended adjuvant therapy.2 If this is true, what is preventing the more widespread use of systemic therapy first for this disease? …