Diagnosis
Recommendation 1.1
➤ After histopathologic confirmation of pancreatic adenocarcinoma, a
multiphase computerized tomography (CT) scan of the chest, abdomen,
and pelvis should be performed to assess extent of disease. Other staging
studies should be performed only as dictated by symptoms (Strong
Recommendation; EB-B-I).
Recommendation 1.2
➤ The baseline performance status (PS), symptom burden, and comorbidity
profile of a patient with metastatic pancreatic cancer should be evaluated
carefully (Strong Recommendation; EB-B-I).
Recommendation 1.3
➤ The goals of care (to include a discussion of an advance directive), patient
preferences, as well as support systems should be discussed with every
patient with metastatic pancreatic cancer and his or her caregivers (Strong
Recommendation; EB-B-I).
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
➤ 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).
Treatment
First Line
Recommendation 2.1
➤ FOLFIRINOX (fluorouracil 400 mg/m
2
bolus, leucovorin 400 mg/m
2
,
fluorouracil 2,400 mg/m
2
over 46 hours, irinotecan 180 mg/m
2
, oxaliplatin
85 mg/m
2
, every 2 weeks) is recommended for patients who meet all of
the following criteria: ECOG PS 0–1, favorable comorbidity profile, patient
preference and support system for aggressive medical therapy, and access
to chemotherapy port and infusion pump management services (Strong
Recommendation; EB-B-I).
