What are the ESMO 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

For patients with advanced/metastatic disease, ESMO recommendations are as follows [63] :

  • For biliary stenting, the endoscopic method is safer than percutaneous insertion and is as successful as surgical hepatojejunostomy

  • Pain control is mandatory and frequently requires consultation with a pain specialist

  • In patients with Eastern Cooperative Oncology Group (ECOG) performance status 3/4, with significant morbidities and a very short life expectancy, only symptomatic treatment can be considered

  • In very selected patients with performance status 2 due to heavy tumor load, gemcitabine and nab-paclitaxel can be considered for best chance of response

  • In patients with performance status 2 and/or bilirubin level higher than 1.5 times the upper limit of normal, monotherapy with gemcitabine should be considered

  • In patients with performance status 0 or 1 and bilirubin level less than 1.5 times the upper limit of normal, combination chemotherapy with either FOLFIRINOX or the combination of gemcitabine and nab-paclitaxel should be considered

  • The efficacy of treatment has to be evaluated every 2 months with a comparative CT scan


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