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.
Molecular diversity of pancreatic cancer requires a paradigm shift towards a genomic-driven therapeutic approach. Unselected treatment strategies demonstrate only limited efficacy in early-stage pancreatic cancer. Personalised treatment in non-metastatic disease has potential to reduce pancreatic cancer mortality. It is fundamental to implement preoperative clinical studies enriched for potential prognostic/predictive biomarkers. Novel models of therapeutic development are warranted to accelerate progress in pancreatic cancer care and research.