Neoadjuvant chemotherapy for rescectable pancreatic cancer: “fashion” or necessity?

The interest in neoadjuvant chemotherapy (NACT) for resectable ductal pancreatic cancer (PC) has increased significantly in recent years, primarily due to unsatisfactory long-term outcomes in these patients. However, oncological rationale for this approach is currently interpreted controversially. Routine NACT for resectable PC remains controversial due to the lack of uniform standards for regimens and number of drug therapy courses, selection criteria, high incidence of chemotherapy-related complications, toxicity, no evidence of benefit for all patients and risks of tumor transition to inoperable category due to delayed surgery. This review is devoted to effectiveness of NACT for resectable PC. The limitations of NACT and biological factors reducing its effectiveness are identified. NACT should not be considered as a standard for resectable PC without individual approach. The main tasks for future research should be criteria for selecting patients for NACT and standardized optimal regimens and number of chemotherapy courses.