Katz and colleagues are to be congratulated in establishing the multicenter Alliance for Clinical Trials in Oncology, which seeks to address, in part, the paucity of quality evidence supporting neoadjuvant therapy (NAT) for borderline resectable pancreatic cancer (BRPC).1 Their preliminary study is about feasibility, quality control, and accrual rates and whether adding radiotherapy to chemotherapy is beneficial, which are all secondary questions. Should the Alliance not “grasp the nettle” and answer the most important question first, which is whether NAT should be the standard of care for BRPCs (if not all resectable cancers) and the “surgery-first” approach retired? The Alliance and the increasing number of centers espousing NAT for BRPC cannot ignore the fact that equipoise still exists and that evidence from a randomized clinical controlled trial is still required to answer the most important question.
Windsor JA. Borderline Resectable Pancreatic CancerAnswering the Most Important Question First. JAMA Surg. 2016;151(8):e161150. doi:10.1001/jamasurg.2016.1150