Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease due to its late presentation and tendency to recur early even after optimal surgical resection. Currently, there are limited options for effective systemic therapy. In addition, PDAC typically generates an immune-suppressive tumor microenvironment; trials of immunotherapy in metastatic PDAC have yielded disappointing results. There is considerable interest in using immunotherapy approaches in the neoadjuvant setting in order to prime the immune system to detect and prevent micrometastatic disease and recurrence. A scoping review was conducted to identify published and ongoing trials utilizing preoperative immunotherapy. In total, 9 published trials and 27 ongoing trials were identified. The published trials included neoadjuvant immune checkpoint inhibitors, cancer vaccines, and other immune-modulating agents that target mechanisms distinct from that of immune checkpoint inhibition. Most of these are early phase trials which suggest improvements in disease-free and overall survival when combined with standard neoadjuvant therapy. Ongoing trials are exploring various combinations of these agents with each other and with chemotherapy and/or radiation. Rational combination immunotherapy in addition to standard neoadjuvant therapy has the potential to improve outcomes in PDAC, but further clinical trials are needed, particularly those which utilize an adaptive trial design.
胰腺导管腺癌（PDAC）因其发现较晚且在最佳手术切除后仍易早期复发的特点，是一种致死率极高的疾病。目前，有效的系统性治疗选择有限。此外，PDAC通常形成免疫抑制性肿瘤微环境；针对转移性PDAC的免疫疗法试验结果令人失望。在新辅助治疗中采用免疫疗法以激活免疫系统识别和预防微转移性疾病及复发，引起了广泛关注。通过范围综述对已发表及正在进行的术前免疫疗法试验进行梳理，共发现9项已发表试验和27项进行中的试验。已发表的试验包括新辅助免疫检查点抑制剂、癌症疫苗以及其他针对非免疫检查点抑制机制的其他免疫调节剂。其中大多数为早期阶段试验，提示其与标准新辅助治疗联用可改善无病生存期和总生存期。进行中的试验正在探索这些药物相互之间以及与化疗和/或放疗的多种联合方案。在标准新辅助治疗基础上联合合理的免疫疗法有望改善PDAC的治疗效果，但仍需进一步临床试验验证，尤其是采用适应性试验设计的研究。
Neoadjuvant Immunotherapy for Localized Pancreatic Cancer: Challenges and Early Results
肿瘤(癌症)患者之家