What are the ASCO treatment guidelines for metastatic pancreatic cancer?

Updated: Mar 07, 2019
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

The 2016 ASCO guidelines include the following recommendations for treatment of metastatic disease [94] :

  • First-line treatment for metastatic pancreatic cancer is the FOLFIRINOX regimen consisting of leucovorin, fluorouracil, irinotecan, and oxaliplatin.
  • The FOLFIRINOX regimen can be offered to anyone with a performance status of 0 or 1 and a favorable comorbidity profile who wants to and is able to withstand an aggressive medical regimen. Alternatively, patients can be treated with gemcitabine plus nanoparticle albumin-bound (NAB)-paclitaxel.
  • For those with more advanced disease (performance status, 2) or who cannot tolerate a more aggressive regimen but who still wish to received cancer-directed therapy, gemcitabine can be given alone or together with either capecitabine or erlotinib.
  • For patients with a performance status 3 or more with poorly controlled comorbid conditions despite ongoing active medical care, emphasis should be on optimizing supportive care measures 
  • For patients who experience either disease progression on first-line therapy or intolerable toxicity, gemcitabine plus NAB-paclitaxel may be used as second-line therapy,
  • If patients received gemcitabine plus NAB-paclitaxel as first-line treatment, fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan can be given as second-line therapy, provided patients want and can tolerate aggressive medical treatment
  • For those who cannot tolerate aggressive therapy, clinicians can offer either gemcitabine or fluorouracil as a second-line option.
  • If patients are on cancer-directed therapy, they should undergo CT scan to assess first response to treatment 2 to 3 months after treatment initiation.
  • Patients should be offered aggressive treatment to control pain and other symptoms related to the cancer or the treatment

ASCO found no data to establish how long cancer-directed therapy should continue or whether a third-line treatment should be used.


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