The role of systemic therapy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma

作     者：Victor C.K.Lo Rachel A.Goodwin Michael M.Vickers Victor C.K.Lo;Rachel A.Goodwin;Michael M.Vickers

作者机构：Department of MedicineDivision of Medical OncologyThe Ottawa Hospital Cancer CentreOttawaON K1H 8L6Canada 

出 版 物：《Journal of Cancer Metastasis and Treatment》 (癌症转移与治疗（英文版）)

年 卷 期：2022年第8卷第1期

页      面：281-292页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Borderline resectable locally advanced pancreatic ductal adenocarcinoma neoadjuvant chemotherapy 

摘      要：Pancreatic ductal adenocarcinoma(PDAC)remains a deadly disease,even in patients whose cancer is localized and *** resection provides the only option for cure,but long-term survival rates remain *** patients with borderline resectable(BR)disease who undergo upfront resection,many patients are either too unwell for subsequent adjuvant systemic therapy,develop recurrence soon after,or are found to have unresectable disease *** is increasing evidence for a neoadjuvant approach,using more conventional multi-agent chemotherapy regimens,which have demonstrated higher activity in the metastatic setting compared to single *** patients with locally advanced(LA)disease,which is unresectable by current definitions,there is mounting evidence that effective neoadjuvant systemic therapy is able to convert some patients’disease to a resectable state,offering the potential for long-term survival and *** we present a review of key trials focusing on prospective,randomized studies to provide high-level evidence supporting a neoadjuvant approach to both BR and LA ***,many knowledge gaps exist,such as the optimal neoadjuvant multi-agent chemotherapy regimen,the role of radiotherapy,and the safety and efficacy of adding immunotherapy to chemo/radiation *** challenges in determining the optimal approach to patients with BR or LA PDAC include not only overcoming the inherent difficulties in conducting complex,multidisciplinary,multicentre randomized trials in patients with a high-morbidity and mortality disease,but also trying to standardize disease definitions,treatment regimens,and outcome measures.