Neoadjuvant therapy for resectable pancreatic cancer

The length and quality of life of patients with localized pancreatic cancer will be maximized by accurate preoperative assessment of resectability, a standardized technique of tumor resection, and the routine use of protocol-based adjuvant or neoadjuvant therapy. Pancreaticoduodenectomy should always be performed as part of a multimodality approach involving chemotherapy or chemoradiation. Continued efforts to enroll patients with localized and advanced pancreatic cancer into well-designed clinical trials should remain a high priority for oncologists across all disciplines. At present, preoperative therapy remains investigational but has a sound clinical basis and remains a reasonable alternative to upfront surgery, particularly in patients with marked elevation in serum levels of CA19-9 or suspicious but unproven extrapancreatic disease. Although molecular therapies are beginning to change the standard of care in other solid tumors, their potential has yet to be realized for patients with resectable pancreatic cancer. No matter what promise these treatments hold, future clinical trials for resectable pancreatic cancer will lead to progress only if the principles of multidisciplinary cancer care and quality assurance are incorporated into their design and conduct.