Metastatic Pancreatic Cancer
Key Points
Key Points
- There will be an estimated 57,600 new cases and 47,050 deaths as a result of pancreatic cancer in the United States in 2020. There were an estimated 460,000 new cases worldwide in 2018.
- A diagnosis of pancreatic ductal adenocarcinoma is associated with poor prognosis due to early micrometastatic spread.
- The 5-year survival rate for metastatic pancreatic cancer is approximately 2.9%.
- This 2020 update of the 2018 recommendations was triggered by:
- New evidence for PARP inhibitor olaparib as an option for maintenance therapy after first-line treatment and
- New studies of tissue agnostic agents that target fusions of the neurotrophin tyrosine receptor kinase (NTRK) 1/2/3 genes.
Diagnosis
Diagnosis
...itial Assessment
...computerized tomography (CT) scan of the chest...
...erformance status (PS), symptom burden, and comorb...
...care (to include a discussion of an advanc...
...tidisciplinary collaboration to for...
...rly testing for actionable genomic alterations...
...ith pancreatic cancer should be off...
Treatment
...reatme...
...Line Treatment...
...LFIRINOX (leucovorin, fluorouracil, irinote...
...e plus NAB-paclitaxel is recommended for pati...
...itabine alone is recommended for patients who...
...th an ECOG PS 3 or with poorly contr...
...Options Following First-Line Th...
...tumors harboring NTRK fusions, treatment...
...1 immune checkpoint inhibitor pembrolizuma...
...atients who have a germline BRCA1 or BRCA2 mutatio...
...ine plus NAB-paclitaxel may be offered as...
...us nanoliposomal irinotecan, or fluorouracil plu...
...l plus oxaliplatin may be considered as second-li...
...tabine or fluorouracil can be conside...
...o data are available to recommend third...
Palliative...
...etastatic pancreatic cancer should have a full a...
...atment of Pain and Symptoms...
...tients with metastatic pancreatic ca...
Follow-Up
...low-Up
For patients on active cancer-directed...
...t on the duration of cancer-directed therapy. An o...