Diagnosis
Recommendation 1.4
➤ Multidisciplinary collaboration to formulate treatment and care plans
and disease management for patients with metastatic pancreatic cancer
should be the standard of care (Strong recommendation; EB-B-I).
Recommendation 1.5 (New)
➤ Early testing for actionable genomic alterations is recommended for
patients who are likely to be potential candidates for additional treatment
following 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 PARP inhibitors, PD-1 checkpoint inhibitor therapy,
TRK fusion inhibitors, and clinical trials of targeted therapies. Genomic
testing is recommended as part of initial assessment to ensure that the
results of testing are available at the time of treatment decision-making
where applicable after first-line therapy (see Treatment Options Following
First-line Therapy) (Strong recommendation; IC).
Qualifying Statement. The decision to test for actionable genomic alterations should involve
a discussion between the patient and physician regarding frequency of actionable findings,
treatment implications of testing results, and genetic counseling related to germline testing.
ASCO has previously developed a provisional clinical opinion (PCO) on Evaluating
Susceptibility to Pancreatic Cancer that contains recommendations for germline genetic
testing.
Recommendation 1.6
➤ 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 (Strong recommendation; IC-B-I).
