Advances of pathological complete response after neoadjuvant therapy for pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis. Only 15% to 20% of patients present with a primarily resectable tumor at the time of diagnosis. There has been an increasing interest in the use of neoadjuvant chemotherapy alone or combination with radiotherapy in patients with resectable, borderline resectable, and locally advanced pancreatic cancer. Although the benefit of neoadjuvant therapy on resectable patients remains controversial, around one third of borderline resectable and locally advanced patients could be expected to have resectable tumors following neoadjuvant therapy, with comparable survival as those with primary resectable tumors. A pathological complete response (pCR) in PDAC is an indicator for significantly better survival although it's rather rare. In this review, we present recent progress of pCR and the controversies in pancreatic cancer after neoadjuvant therapy.