J.Jpn. Surg. Soc.. 124(5): 410-415, 2023

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CHEMOTHERAPY FOR BILIARY AND PANCREATIC CANCER

Biliary and pancreatic cancers are both refractory malignancies with poor prognosis. Common features include difficulty in early diagnosis, low sensitivity to chemotherapy and radiation, and high incidence of postoperative recurrence. Although curative resection has been a key intervention for cure, it is difficult to achieve by surgery alone. Recent advances in chemotherapy and paradigm shifts in treatment strategies have led to improved prognosis in these dismal diseases. The development of new drugs and advances in adjuvant therapy have contributed to improved clinical outcomes. In biliary cancer, standard regimens for unresectable disease have been established, and the efficacy of adjuvant therapy has been demonstrated. Molecularly targeted drugs and immune checkpoint inhibitors have also been incorporated in daily practice. In pancreatic cancer, evidence of the effectiveness of neoadjuvant therapy has been presented, and it is widely used in combination with postoperative adjuvant therapy, while multiagent regimens for unresectable cancer have become the standard of care. It is expected that a treatment strategy will be established in which surgery is positioned as part of a multidisciplinary regimen that includes conversion surgery for initially unresectable cancer. Further progress in overcoming these intractable cancers is expected in the future.

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