Shanghai Pancreatic Cancer Institute, Shanghai, China.
Pancreatic Cancer Institute, Fudan University, Shanghai, China.
Curr Med Chem. 2019;26(40):7196-7211. doi: 10.2174/0929867325666180413101722.
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.
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.
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.
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.
人们对新辅助治疗益处的认识不断提高，但对于可切除胰腺癌患者，新辅助治疗作为初始治疗选择仍存在争议，特别是对于那些没有高危预后特征的患者。即使对于有高危特征且适合接受新辅助治疗的患者，也没有标准的治疗方案。
在本综述中，我们通过检索 PubMed/MEDLINE、ClinicalTrials.gov、Web of Science 和 Cochrane Library，查阅了可切除胰腺癌患者新辅助治疗的相关研究，包括前瞻性研究、回顾性研究和正在进行的临床试验，以评估现有数据。描述了筛选研究的特征和结果。
纳入了有报告结果的回顾性和前瞻性研究以及正在进行的随机研究。对于可切除胰腺癌患者，新辅助治疗可带来生存获益增加、合并症和死亡率降低风险，以及因多模式治疗完成率提高而具有成本效益等优势。氟尿嘧啶、伊立替康、奥沙利铂和亚叶酸钙（FOLFIRINOX）或吉西他滨联合白蛋白紫杉醇等高度有效的方案被认为是可接受的治疗方案。此外，除 FOLFIRINOX 以外的含铂方案也可用于部分患者。其他治疗方法，如放化疗、免疫肿瘤学药物和靶向治疗，也正在探索中，结果令人期待。
本综述强调了新辅助治疗在可切除胰腺癌中的益处。目前一些方案是可接受的，但需要更多来自精心设计的临床试验的证据，或应由多学科团队仔细评估后使用。
