Metastatic Pancreatic Cancer

A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed to assess the extent of disease. Other staging studies should be performed only as dictated by symptoms. (EB, B, S, I)

The baseline performance status (PS), symptom burden, and comorbidity profile of a patient with metastatic pancreatic cancer should be evaluated carefully. (EB, B, S, I)

The goals of care (to include a discussion of an advance directive), patient preferences, and support systems should be discussed with every patient with metastatic pancreatic cancer and his or her caregivers. (EB, B, S, I)

Multidisciplinary collaboration to formulate treatment and care plans and disease management for patients with metastatic pancreatic cancer should be the standard of care. (EB, B, S, I)

Early testing for actionable genomic alterations is recommended for patients who are likely to be potential candidates for additional treatment after first-line therapy.
Both germline and tumor (somatic) testing are recommended. This includes testing for microsatellite instability/mismatch repair deficiency, BRCA mutations (excluding variants of unknown significance), and NTRK gene fusions. Results of testing can lead to therapies, such as poly (ADP-ribose) polymerase inhibitors, programmed death-1 checkpoint inhibitor therapy, TRK fusion inhibitors, and clinical trials of targeted therapies. Genomic testing is recommended as part of an initial assessment to ensure that the results of testing are available at the time of treatment decision where applicable after first-line therapy (see Treatment Options After First-Line Therapy)

Every patient with pancreatic cancer should be offered information about clinical trials, which include therapeutic trials in all lines of treatment as well as palliative care, biorepository/biomarker, and observational studies. (IC, B, S, I)