Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer

Ann Oncol. 2013 Oct;24(10):2484-92. doi: 10.1093/annonc/mdt239. Epub 2013 Jul 12.


Neoadjuvant therapy is increasingly becoming a valid treatment option for patients with locally advanced pancreatic cancer (LAPC). In borderline resectable disease, neoadjuvant therapy is employed to improve the probability of margin-clear resections. In non-metastatic, non-resectable pancreatic cancer, treatment primarily aims to induce disease control, but may achieve conversion to surgical resectability in some patients. Several treatment modalities including chemotherapy, chemoradiotherapy (CRT) or the sequential use of both have been investigated in numerous, mostly small and non-randomized studies. Nevertheless, there is a consistent finding that neoadjuvant therapy can induce resectability in up to 30%-40% of LAPC patients. Once resection has been achieved, overall survival appears to be comparable to that observed for primarily resectable patients. Thus, patient selection evolves as an important aspect of neoadjuvant therapy; retrospective analyses identified induction chemotherapy as an appropriate tool to define LAPC patients who may benefit most from subsequent treatment with CRT. The clinical importance of induction chemotherapy may further increase once highly active protocols such as the FOLFIRINOX or the gemcitabine plus nab-paclitaxel regimen are introduced into novel multimodality treatment concepts.

Keywords: chemoradiotherapy; chemotherapy; neoadjuvant; pancreatic cancer.

Publication types

  • Review

MeSH terms

  • Albumins / therapeutic use
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Chemoradiotherapy, Adjuvant / methods*
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / therapeutic use
  • Fluorouracil / therapeutic use
  • Humans
  • Neoadjuvant Therapy / methods*
  • Paclitaxel / therapeutic use
  • Pancreatectomy
  • Pancreatic Neoplasms* / drug therapy
  • Pancreatic Neoplasms* / mortality
  • Pancreatic Neoplasms* / surgery
  • Survival
  • Treatment Outcome


  • 130-nm albumin-bound paclitaxel
  • Albumins
  • Antimetabolites, Antineoplastic
  • Antineoplastic Agents, Phytogenic
  • Deoxycytidine
  • gemcitabine
  • Paclitaxel
  • Fluorouracil