title: Neoadjuvant multimodal treatment of pancreatic ductal adenocarcinoma.
abstract: Treatment of pancreatic ductal adenocarcinoma (PDAC) is increasingly multidisciplinary, with neoadjuvant strategies (chemotherapy, radiation, and surgery) administered in patients with resectable, borderline resectable, or locally advanced disease. The rational supporting this management is the achievement of both higher margin-negative resections and conversion rates into potentially resectable disease and in vivo assessment of novel therapeutics. International guidelines suggest an initial staging of the disease followed by a multidisciplinary approach, even considering the lack of a treatment approach to be considered as standard in this setting. This review will focus on both literature data supporting these guidelines and on new opportunities related to current more active chemotherapy regimens. An analysis of the pathological assessment of response to therapy and the potential role of target therapies and translational biomarkers and ongoing clinical trials of significance will be discussed.
authors.affiliation: Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy. Electronic address: n.silvestris@oncologico.bari.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
authors.affiliation: Medical Oncology Unit, 'Mons R Dimiccoli' Hospital, Barletta, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Longo
authors.affiliation: Radiation Oncology Department, Policlinico Universitario Campus Bio-Medico, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cellini
authors.affiliation: Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Medical Oncology Clinic, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bittoni
authors.affiliation: ARC-NET Research Centre, University of Verona, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Cataldo
authors.affiliation: Pancreatic Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.affiliation: Pancreatic Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: ARC-NET Research Centre, University of Verona, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy.
authors.forename: Oronzo
authors.initials: O
authors.lastname: Brunetti
authors.affiliation: Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
authors.affiliation: Medical Oncology Unit, University Campus Biomedico, Roma, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: Radiation Oncology Center, Dept. of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Morganti
authors.affiliation: Radiation Oncology Department, Policlinico Universitario Campus Bio-Medico, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Medical Oncology Clinic, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D021441:Carcinoma, Pancreatic Ductal / Q000628:therapy*; D059248:Chemoradiotherapy; D002986:Clinical Trials as Topic; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000628:therapy*
keywords: Borderline; Chemotherapy; Locally advanced; Neoadjuvant; Pancreatic ductal adenocarcinoma; Radiotherapy; Target therapy