What are the ASCO treatment guidelines for locally advanced, unresectable pancreatic cancer?

Updated: Oct 02, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The 2016 ASCO guidelines include the following recommendations for treatment of locally advanced, unresectable disease [97] :

  • Multiphase CT scans to assess disease extent in the chest, abdomen, and pelvis. Other staging studies should be performed only as dictated by symptoms 
  • Patients should also be assessed for baseline performance status, symptom burden, and comorbidities, and clinicians again need to discuss the goals of treatment in collaboration with a multidisciplinary team shaped by patient preferences.
  • Patients should  be informed about any relevant clinical trials for which they might be eligible.
  • Initial treatment should include some form of combination regimen for individuals who have a performance status of 0 or 1, who have a favorable comorbidity profile, and who want to and are able to undergo an aggressive medical regimen.
  • There is no clear evidence to support one regimen over another and therapy may be offered on the basis of extrapolation from data derived from studies in the metastatic setting.
  • Chemoradiotherapy (CRT) or stereotactic body radiotherapy (SBRT) may be offered to patients with local progression but no metastases, provided they have a performance status of 2 or less and a favorable comorbidity profile.
  • CRT or SBRT may be offered to patients who have responded to an initial 6 months of chemotherapy or have stable disease, have developed unacceptable chemotherapy-related toxicities, or have a decline in performance status as a consequences of chemotherapy toxicity
  • If patients respond or their disease has at least stabilized after 6 months of induction chemotherapy, CRT or SBRT may be offered as an alternative to continuing chemotherapy alone
  • SBRT may be offered even though evidence supporting SBRT is not robust.

On completion of treatment, patients whose disease has stabilized or who have no disease progression should have a follow-up visit every 2 to 3 months in which they undergo liver and renal function tests. They should also be tested for CA 19-9 levels and undergo CT scans at least every 3 months in the first 2 years after completion of treatment, and every 6 months if disease remains stable. [97]

Patients who do not benefit from first-line treatment recommendations and who progress despite clinicians' best efforts should be treated according to the ASCO guidelines for the treatment of metastatic pancreatic cancer. [97]

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