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A Qualitative Review of Neoadjuvant Chemotherapy in Resectable Pancreatic Adenocarcinoma

Blair, Alex B. MD*,†; Sorber, Rebecca MD*,†; Rozich, Noah S. MD*,†; Burkhart, Richard A. MD*,†

doi: 10.1097/MPA.0000000000001376

The aim of this study was to evaluate outcomes of patients with resectable pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy. The MEDLINE and PubMed databases were searched to identify relevant original articles investigating neoadjuvant therapy in resectable PDAC. Qualitative analyses were performed to investigate patient selection, disease stage, impact on perioperative outcomes, and cost-effectiveness. Forty-three studies met inclusion criteria for this review. Neoadjuvant chemotherapy for upfront resectable PDAC is cost-effective, safe, may result in lower stage disease and has potential survival advantages. With proper patient selection, neoadjuvant chemotherapy is an appropriate approach for upfront resectable PDAC. Nevertheless, the risk for disease progression and losing a curative surgical window highlights the need for appropriate patient identification, further discovery of superior biomarkers or molecular profiles representative of positive treatment response, and additional prospective comparative study.

From the *Section of Hepatobiliary and Pancreatic Surgery, Division of Surgical Oncology, Johns Hopkins Hospital

The Pancreatic Cancer Precision Medicine Center of Excellence Program, Johns Hopkins University School of Medicine, Baltimore, MD.

Received for publication March 4, 2019; accepted July 3, 2019.

Address correspondence to: Richard A. Burkhart, MD, Blalock 685, 600 N Wolfe Street, Baltimore, MD 21287 (e-mail:

This work was supported in part by NIH grant T32 CA126607 (ABB and NR).

The authors declare no conflict of interest.

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