Fast Five Quiz: Test Your Knowledge of the Diagnosis and Treatment of Locally Advanced, Unresectable Pancreatic Cancer

Michael J. Pishvaian, MD, PhD


September 26, 2018

NCCN first-line chemotherapy guidelines for locally advanced disease include the following recommendations:

  • FOLFIRINOX or gemcitabine plus nab-paclitaxel is a first-line treatment for patients who have good performance status.

  • Gemcitabine monotherapy, or palliative therapy and best supportive care, is recommended for locally advanced unresectable disease in symptomatic patients with poor performance status.

  • Various additional options for patients with both good and poor performance status can be found in the full NCCN guidelines for first-line chemotherapy for locally advanced pancreatic adenocarcinoma.

In patients with locally advanced (unresectable) tumors, ESMO recommendations are as follows:

  • The standard of care is 6 months of gemcitabine.

  • Per ESMO guidelines, chemoradiation may have a minor role, but no regimen other than the combination of capecitabine and radiotherapy can be recommended. ESMO notes that trials have showed conflicting evidence regarding survival benefit with chemoradiation. ESMO recommendations currently remain unchanged pending results of further trials.

Further discussion can be found in the ESMO guidelines for locally advanced, unresectable pancreatic cancer. For summaries of NCCN and ESMO guidelines, read here.


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