Reshaping preoperative treatment of pancreatic cancer in the era of precision medicine

Casolino R (1,2), Braconi C (1), Malleo G (3), Paiella S (3), Bassi G (3), Milella M (4), Dreyer SB (1,5), Froeling FEM (6), Chang DK (1,5), Biankin AV (1,5,7), Golan T (8)
(1) Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, Scotland, UK;
Departments of (2) Medicine; (3) Surgery; (4) Medicine, Medical Oncology, University and Hospital Trust of Verona, Verona (VR), Italy
(5) West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow
(6) Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
(7) South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool, NSW, Australia
(8) Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel

This review summarises the recent evidence on preoperative therapeutic strategies in pancreatic cancer and discusses the rationale for an imminent need for a personalised therapeutic approach in non-metastatic disease. The molecular diversity of pancreatic cancer and its influence on prognosis and treatment response, combined with the failure of ‘all-comer’ treatments to significantly impact on patient outcomes, requires a paradigm shift towards a genomic-driven approach. This is particularly important in the preoperative, potentially curable setting, where a personalised treatment allocation has the substantial potential to reduce pancreatic cancer mortality.