Recommendation ID

Neoadjuvant therapy:- Prospective randomised trials should be undertaken to compare preoperative (neoadjuvant) therapy with standard postoperative therapy in people with resectable pancreatic cancer.

Any explanatory notes
(if applicable)

Why this is important:- The survival rate of pancreatic cancer after surgical resection is very low, which suggests that most patients have metastatic disease at the time of surgery. In addition, complications of surgery may stop people from having adjuvant therapy. This makes neoadjuvant therapy an attractive option. However, the evidence for neoadjuvant therapy is limited and low quality. Using neoadjuvant therapy means delaying surgery, and it is possible that during this delay pancreatic cancer will progress and become unresectable in some people, negating any benefit of neoadjuvant therapy.
Research is needed to compare neoadjuvant treatments (which might be chemotherapy, radiotherapy or both) with surgery followed by adjuvant chemotherapy. The outcomes of interest are:
- feasibility of delivering neoadjuvant treatment
- feasibility of randomising patients
- objective response rate of neoadjuvant therapy
- R0 resection rate
- surgical complications, length of hospital stay, mortality of surgery
- delivery of planned treatment
- disease-free survival and overall survival after surgery
- quality of life, patient experience and patient-reported outcome measures.

Source guidance details

Comes from guidance
Pancreatic cancer in adults: diagnosis and management
Date issued
February 2018

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2018