Treatment Strategies and Future Directions for Locally Advanced Pancreatic Cancer

Locally advanced pancreatic cancer is a complex clinical entity, combining a locally aggressive tumor in a disease marked by systemic failure. Accordingly, systemic therapy upfront is recommended, with translation of recent advances in the metastatic setting promising to revolutionize the care of locally advanced disease in the future. In those patients where systemic disease remains controlled, locoregional therapies including surgery and radiation may play a role. Specific considerations of these therapies are presented in a disease phenotype marked by invasion into surrounding vasculature/luminal organs. Ongoing investigations are set to define the role of novel therapies in locally advanced disease, some of which have already gained approval. With recent advances in the control of systemic disease, locally advanced disease represents a prime target for study and treatment optimization to improve outcomes for patients.