In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?

There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...

I agree with Dr. @Dr. First Last, but would like to add a few more comments. There are other benefits to the neoadjuvant chemotherapy. The chance of successful delivery of chemotherapy is higher in the neoadjuvant setting, as opposed to post-surgical, specifically post-Whipple surgery. The other poi...

The management of resectable pancreatic adenocarcinoma is evolving. While upfront surgery remains a standard, a neoadjuvant strategy is increasingly supported for patients with high-risk features, irrespective of tumor location. The primary rationale is the high rate of occult micrometastases at dia...

I agree completely with @Dr. First Last and @Dr. First Last. We know that patients have the greatest chance of success if they receive surgery and sufficient chemotherapy for localized pancreatic cancer. Giving chemotherapy up front does increase the likelihood of giving sufficient perioperative che...

The question was about “clearly resectable” disease, so my answer is: no, unless the patient is enrolled in a clinical trial.
In the absence of proven benefit, why should one risk disease progression during chemotherapy, making clearly resectable disease unresectable?

The recently published phase 2 German trial NORPACT-1 (Labori et al., PMID 38237621) compared neoadjuvant FOLFIRINOX to standard adjuvant chemotherapy and found the neoadjuvant group to be inferior to the upfront surgery arm, with a 13% median survival decrement (25 vs 38 months). The authors sugges...