What is your preferred neoadjuvant chemotherapy regimen for borderline resectable pancreatic ductal adenocarcinoma?

Agree while guidelines for the use of adjuvant therapy in resected PDAC are stronger (6 mos therapy for T1N0 tumors or greater), those for the use of neoadjuvant therapy are less clear. Some guidelines recommend not to use NAT unless there is a radiographic interface with mesenteric vessels, or in t...

We typically use FOLFIRINOX as well and monitor with FDG PET, MRI, and CT. Metabolic response is associated with path response (not surprising) and also OS. The results from our group have been reported and extended duration of chemo as well as CA19-9 normalization and path response predicted better...

In borderline resectable disease, no randomized phase III trials have compared the approach of neoadjuvant therapy to the upfront surgery, and the best regimens to use in the borderline neoadjuvant setting are unknown. For patients who appear technically resectable but have poor prognostic features ...

Based on the publication of (Reni et al., PMID 41275879), PAXG is a reasonable and evidence-supported neoadjuvant option for borderline resectable PDAC, and it has appropriately been incorporated into NCCN guidelines.

Overall survival data remain immature — EFS, while a meaningful endpoint, has not b...