Background: Awareness of the benefits of neoadjuvant therapy is increasing, but its use as an
initial therapeutic option for patients with resectable pancreatic cancer remains controversial, especially
for those patients without high-risk prognostic features. Even for patients with high-risk features who are
candidates to receive neoadjuvant therapy, no standard regimen exists.
Methods: In this review, we examined available data on the neoadjuvant therapy in patients with resectable
pancreatic cancer, including prospective studies, retrospective studies, and ongoing clinical trials,
by searching PubMed/MEDLINE, ClinicalTrials.gov, Web of Science, and Cochrane Library. The characteristics
and results of screened studies were described.
Results: Retrospective and prospective studies with reported results and ongoing randomized studies were
included. For patients with resectable pancreatic cancer, neoadjuvant therapy provides benefits such as
increased survival, decreased risk of comorbidities and mortality, and improved cost-effectiveness due to
an increased completion rate of multimodal treatment. Highly active regimens such as FOLFIRINOX (folinic
acid, fluorouracil, irinotecan, and oxaliplatin) or gemcitabine plus nab-paclitaxel are considered acceptable
therapeutic regimens. Additionally, platinum-containing regimens other than FOLFIRINOX are
acceptable for selected patients. Other therapies, such as chemoradiation treatment, immuno-oncology
agents, and targeted therapies are being explored and the results are highly anticipated.
Conclusion: This review highlights the benefits of neoadjuvant therapy for resectable pancreatic cancer.
Some regimens are currently acceptable, but need more evidence from well-designed clinical trials or
should be used after being carefully examined by a multidisciplinary team.