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Koukourakis et al. J Cancer Metastasis Treat 2022;8:38 Journal of Cancer
DOI: 10.20517/2394-4722.2022.43
Metastasis and Treatment

Review Open Access

Neoadjuvant treatment of pancreatic ductal
adenocarcinoma: present and future

1
1,2
3
1,2
Ioannis M. Koukourakis , Dimitra Desse , Marios Papadimitriou , Manousos Konstadoulakis , Anna
2
Zygogianni , Christos Papadimitriou 1
1
Oncology Unit, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens 115 28, Greece.
2
Radiation Oncology Unit, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens 115 28, Greece.
3
Second Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens 115 28,
Greece.
Correspondence to: Dr. Ioannis M. Koukourakis, MD, Oncology Unit, Aretaieio University Hospital, National and
Kapodistrian University of Athens, V. Sophias 76, Athens 115 28, Greece. E-mail: koukourioannis@gmail.com
How to cite this article: Koukourakis IM, Desse D, Papadimitriou M, Konstadoulakis M, Zygogianni A, Papadimitriou C.
Neoadjuvant treatment of pancreatic ductal adenocarcinoma: present and future. J Cancer Metastasis Treat 2022;8:38.
https://dx.doi.org/10.20517/2394-4722.2022.43
Received: 30 Apr 2022 First Decision: 13 Jun 2022 Revised: 1 Jul 2022 Accepted: 7 Sep 2022 Published: 18 Sep 2022

Academic Editors: Antonio Facciorusso, Palanisamy Nallasamy Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Pancreatic ductal adenocarcinoma is a highly aggressive malignancy with a poor prognosis. Effective treatment
with acceptable outcomes is yet to be found, with chemo- and radioresistance comprising major impediments
towards this goal. Although upfront surgery is the established therapeutic approach for resectable and borderline
resectable disease, neoadjuvant treatment has recently monopolized the interest in clinical trials. This also applies
to locally advanced pancreatic adenocarcinomas that could potentially be rendered operable. Chemotherapy and
chemoradiotherapy are the most utilized therapeutic modalities in the neoadjuvant setting, while immunotherapy
and targeting agents have been gaining significant attention. This critical review focuses on the clinical experience
gained from retrospective and phase II/III randomized trials, reporting on the outcomes of neoadjuvant
chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma. Moreover, the ongoing trials, including
those that involve immunotherapy and targeting agents, are summarized.

Keywords: Pancreatic cancer, neoadjuvant treatment, chemotherapy, radiotherapy, surgery, immunotherapy

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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