Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Over the past decade, significant therapeutic advancements have improved the survival rates of patients with pancreatic cancer. One of the primary factors contributing to these positive outcomes is the evolution of chemotherapy, from monotherapy to doublet or triplet regimens, and the integration of multimodal approaches. Additionally, targeted agents tailored to patients with specific genetic alterations and the development of cell therapies show promise in benefiting certain subpopulations. This article focuses on examining pivotal studies that explore the role of chemotherapy in neoadjuvant, adjuvant, maintenance, and salvage settings; highlights interesting findings related to cell therapy; and provides an overview of ongoing trials concerning metastatic settings. This review primarily aimed to offer recommendations based on therapeutic evidence, recent advancements in new treatment combinations, and the most innovative approaches. A unique aspect of this review is the inclusion of published papers on clinical trials and real-world data in Taiwan, thus adding a valuable perspective to the overall analysis.

(1) Background: Neoadjuvant therapy is widely used to treat locally advanced breast cancer. It has been recently shown that it can also improve the prognosis of patients during the early stages of breast cancer. In the past, advanced breast cancer with positive Human Epidermal growth factor Receptor 2 (HER2+) resulted in poor prognoses; however, outcomes have since changed after the introduction of HER2-targeting therapy. Achieving pathological Complete Response (pCR) is the most important aim, as it is a predictor of long-term outcomes in high-risk breast cancer subtypes. (2) Methods: We performed a retrospective review of all breast cancer patients who were treated with neoadjuvant therapy at Taichung Veterans General Hospital (VGHTC) between 2010 and 2018. A total of 147 HER2+ breast cancer patients who underwent neoadjuvant chemotherapy involving anthracycline and taxane-based regimens were enrolled. Within that population, 95 and 52 cases received single-blockade (Trastuzumab) and dual-blockade (Trastuzumab and Pertuzumab) neoadjuvant anti-HER2 therapy, respectively. (3) Results: The dual-blockade therapy group displayed a significantly higher pCR rate after surgery as compared to the single-blockade group (63.5% vs. 43.2%, p = 0.019). Advanced stage, larger tumor size, lymph node involvement and HER2 expression status were associated with the pCR rate. The 4-year OS was 85.2% and 100% in the single-blockage and dual-blockade therapy groups, respectively (p = 0.041). (4) Conclusion: Anthracycline, followed by taxane-based neoadjuvant chemotherapy combined with the dual HER2-blockade, had a higher pCR rate and better outcome when compared with the single HER2-blockade strategy in locally advanced HER2 breast cancer.

Background/Objectives: Older adults with gastric cancer often have poorer prognoses than younger patients. Early recurrence, within two years after curative surgery, is associated with poor outcomes, but its risk factors remain unclear. This study aimed to identify clinicopathological predictors of early recurrence in older patients with stage II/III disease. Methods: We retrospectively reviewed 604 patients with stage II/III gastric cancer who underwent curative surgery from 2009 to 2020. After exclusions, 237 patients aged ≥65 years were analyzed. Clinicopathological variables were compared between those with and without early recurrence, and risk factors were assessed using logistic regression. Results: Among the 237 patients studied, 103 had recurrence following surgery, of whom 72 (69.9%) were categorized as early recurrence. Distant metastasis was the most common pattern (59.7%), followed by peritoneal (45.8%) and locoregional (33.3%) recurrences. Multivariate analysis identified a lymph node ratio (LNR) > 0.17 as an independent risk factor for early recurrence (odds ratio (OR), 5.30; 95% confidence interval (CI), 2.07–13.53; p < 0.001). Conclusions: Early recurrence is frequent among older patients with stage II/III gastric cancer, with distant metastasis as the predominant pattern. An LNR > 0.17 predicts higher recurrence risk. While adjuvant chemotherapy showed a trend toward reduced risk, statistical significance was not reached. Further prospective studies are necessary to confirm these findings.

Background: Increasingly, more evidence has shown that inflammation stress and the tumor microenvironment pose a negative effect on targeted therapy. The neutrophil-to-lymphocyte ratio is considered to be a surrogate biomarker of inflammation and can predict pazopanib treatment effect in non-adipocytic soft-tissue sarcoma (STS). The role of the pan-immune-inflammation value (PIV) in STS is still yet to be determined. Objectives: We sought whether the pre-treatment PIV could be applied to predict the response of pazopanib in STS. Design: We conducted a retrospective analysis of 75 patients who had been treated with pazopanib for recurrent or metastatic non-adipocytic STS. Methods: Our cohort was stratified into either a pre-treatment high PIV group with PIV ⩾310 ( n = 45) or a low PIV group with PIV <310 ( n = 30). We compared their clinical features and outcomes. Cox regression analysis was employed to determine the risk factors of disease progression and mortality. Kaplan–Meier survival curves were utilized to assess both the progression-free survival (PFS) and overall survival (OS). Results: The results revealed that a pre-treatment high PIV (⩾310) is a risk factor for progression under pazopanib (hazard ratio: 1.91; 95% confidence interval: 1.08–3.36; p = 0.025). The median PFS and OS of the pre-treatment high PIV group were found to be significantly lower than the low PIV group (0.33 vs 0.75 years; p = 0.023, 0.46 vs 1.63 years; p = 0.025). Conclusion: High pre-treatment PIV in STS patients may indicate an elevated risk of disease progression and mortality. Pre-treatment PIV reflects inflammation stress and acts as a practical biomarker for STS patients treated with pazopanib.

Background: Gallbladder cancer (GBC) represents a rare but aggressive malignancy, often diagnosed at an advanced stage. Although immune checkpoint inhibitors have improved outcomes in biliary tract cancers, GBC-specific evidence remains limited due to underrepresentation in pivotal clinical trials. Objectives: To evaluate the real-world effectiveness and safety of durvalumab combined with gemcitabine and cisplatin (Durva + gemcitabine and cisplatin (GemCis)) compared to GemCis alone in patients with advanced GBC. Design: Retrospective, multi-institutional cohort study. Methods: Data were collected from the TriNetX Global Collaborative Network. Adults diagnosed with advanced GBC between January 2020 and January 2025 who received Durva + GemCis or GemCis as first-line therapy were included. Propensity score matching (1:1) was performed based on age, sex, race, metastatic sites, and tumor marker levels. The primary outcome was overall survival (OS), whereas secondary outcomes included adverse events (AEs). Results: Among 2458 patients with advanced GBC, 130 received Durva + GemCis and 201 received GemCis. After matching, 111 patients per group were analyzed. Median OS was significantly longer in the Durva + GemCis group compared to the GemCis group (13.1 vs 8.5 months; log-rank p = 0.028). Most AEs were comparable between groups; however, malaise and fatigue were more frequently reported in the Durva group (28.8% vs 16.2%; hazard ratio: 1.98, 95% confidence interval: 1.11–3.53). Conclusion: In this real-world study, the addition of durvalumab to GemCis was associated with improved OS in patients with advanced GBC, with a manageable safety profile. These exploratory findings should be interpreted with caution, underscoring the need for dedicated GBC-specific prospective trials.

Adjuvant chemotherapy is the standard form of care for resected pancreatic cancer (PC) patients. Its treatment regimens include monotherapy with gemcitabine or S-1 and combination therapy with gemcitabine plus capecitabine or modified FOLFIRINOX (fluorouracil, oxaliplatin, irinotecan, leucovorin). Whether the efficacy of the adjuvant gemcitabine plus S-1 (GS) combination is realized remains uncertain. This single-institute, retrospective, real-world study included 122 patients with resected PC from the period January 2014 to July 2021. Amongst them, 73 patients received adjuvant chemotherapy, with 21 and 35 patients receiving gemcitabine monotherapy and GS combination adjuvant chemotherapy, respectively. The clinical characteristics, outcomes and toxicities of chemotherapy were compared between these two groups. The disease-free survival (DFS) and overall survival (OS) for the patients who had received GS combination were 15.8 months and 31.2 months, respectively. Compared with gemcitabine monotherapy, there was a trend towards favorable DFS (10.7 months in gemcitabine monotherapy, p = 0.083), but no OS benefits (24 months, p = 0.517) with GS combination. However, for patients in an advanced disease condition (Stages II and III), the GS combination offered statistically significant longer DFS (14.9 vs. 8.8 months; p = 0.015) and OS (31.2 vs. 21.6 months; p = 0.036), when compared with gemcitabine monotherapy. The adverse effects were comparable between the two groups. In our real-world study, use of the GS combination could be another option for resected PC patients, particularly for those who are in a more advanced (Stage II and III) disease condition.