Metastatic pancreatic cancer: American Society of Clinical Oncology clinical practice guideline Journal Article


Authors: Sohal, D. P. S.; Mangu, P. B.; Khorana, A. A.; Shah, M. A.; Philip, P. A.; O'Reilly, E. M.; Uronis, H. E.; Ramanathan, R. K.; Crane, C. H.; Engebretson, A.; Ruggiero, J. T.; Copur, M. S.; Lau, M.; Urba, S.; Laheru, D.
Article Title: Metastatic pancreatic cancer: American Society of Clinical Oncology clinical practice guideline
Abstract: Purpose: To provide evidence-based recommendations to oncologists and others for the treatment of patients with metastatic pancreatic cancer. Methods: American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts to conduct a systematic review of the literature from April 2004 to June 2015. Outcomes were overall survival, disease-free survival, progression-free survival, and adverse events. Results: Twenty-four randomized controlled trials met the systematic review criteria. Recommendations A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. Goals of care, patient preferences, treatment response, psychological status, support systems, and symptom burden should guide decisions for treatments. A palliative care referral should occur at first visit. FOL-FIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin; favorable comorbidity profile) or gemcitabine plus nanoparticle albumin-bound (NAB)-paclitaxel (adequate comorbidity profile) should be offered to patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1 based on patient preference and support system available. Gemcitabine alone is recommended for patients with ECOG PS 2 or with a comorbidity profile that precludes other regimens; the addition of capecitabine or erlotinib may be offered. Patients with an ECOG PS > 3 and poorly controlled comorbid conditions should be offered cancer-directed therapy only on a case-by-case basis; supportive care should be emphasized. For second-line therapy, gemcitabine plus NAB-paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX, an ECOG PS 0to 1, and a favorable comorbidity profile; fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan should be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, ECOG PS 0to 1, and favorable comorbidity profile, and gemcitabine or fluorouracil should be offered to patients with either an ECOG PS 2 or a comorbidity profile that precludes other regimens. Additional information is available at www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 23
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-08-10
Start Page: 2784
End Page: 2796
Language: English
DOI: 10.1200/jco.2016.67.1412
PROVIDER: scopus
PUBMED: 27247222
PMCID: PMC5019760
DOI/URL:
Notes: Review -- Export Date: 1 September 2016 -- Source: Scopus
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  1. Eileen O'Reilly
    316 O'Reilly