Neoadjuvant Therapy (NAT) in Localized Pancreatic Cancer: Should We Do It and What Should We Do?

In 2019, approximately 56,770 new cases of pancreatic cancer were diagnosed in the United States, resulting in an estimated 45,750 deaths. Pancreatic cancer is one of the leading causes of cancer-related death, with a five-year survival rate of 9% [1]. Based on the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic adenocarcinoma, multi-center analyses have validated that poorer prognosis is associated with node-positive disease (N1 and N2) [2,3]. Specifically, five-year survival rates were significantly lower with the increasing N stage: 35.6% in N0, 20.8% in N1, and 10.9% in N2, reflecting relatively better survival in organ confined pancreatic cancer, compared to node positive disease [3]. To date, the most effective treatment for pancreatic cancer is known to be surgical resection, partly due to the intrinsic resistance of pancreatic cancer cells to systemic therapy or radiotherapy. Unfortunately, only 15–20% of patients are candidates for surgical resection as most patients are diagnosed with locally advanced or metastatic disease, due to a lack of effective pancreatic cancer screening methods. However, the prognosis of pancreatic cancer is still grim even in those with resectable disease.