First-Line Treatment
Recommendation 2.1
➤ FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin) is
recommended for patients who meet all of the following criteria: an
ECOG PS of 0 to 1, favorable comorbidity profile, patient preference
and a support system for aggressive medical therapy, and access to
chemotherapy port and infusion pump management services (Strong
recommendation; EB-B-I).
Recommendation 2.2
➤ Gemcitabine plus NAB-paclitaxel is recommended for patients
who meet all of the following criteria: an ECOG PS of 0 to 1, a
relatively favorable comorbidity profile, and patient preference and
a support system for relatively aggressive medical therapy (Strong
recommendation; EB-B-I).
Recommendation 2.3 (Updated)
➤ Gemcitabine alone is recommended for patients who have either an
ECOG PS of 2 or a comorbidity profile that precludes more aggressive
regimens and who wish to pursue cancer-directed therapy. The addition
of nab-paclitaxel or capecitabine or erlotinib to gemcitabine may be
offered in this setting, with proactive dose and schedule adjustments to
minimize toxicities (Moderate recommendation; EB-B-I).
Recommendation 2.4
➤ Patients with an ECOG PS 3 or with poorly controlled comorbid
conditions despite ongoing active medical care should be offered
cancer-directed therapy only on a case-by-case basis. The major
emphasis should be on optimizing supportive care measures (Moderate
recommendation; EB-B-I).
Treatment
