Treatment
Recommendation 2.2
➤ Gemcitabine plus nanoparticle albumin-bound (NAB) paclitaxel
(gemcitabine 1,000 mg/m
2
, NAB-paclitaxel 125 mg/m
2
, days 1, 8,
15, every 4 weeks) is recommended for patients who meet all of the
following criteria: ECOG PS 0–1, relatively favorable comorbidity profile,
and patient preference and support system for relatively aggressive
medical therapy (Strong Recommendation; EB-B-I).
Recommendation 2.3
➤ Gemcitabine alone is recommended for patients who have either an
ECOG PS 2 or a comorbidity profile that precludes more-aggressive
regimens and who wish to pursue cancer-directed therapy. The addition
of either capecitabine or erlotinib to gemcitabine may be offered in this
setting (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).
Disease Progression or Intolerable Toxicity
Recommendation 3.1
➤ Gemcitabine plus NAB-paclitaxel can be offered as second-line therapy
for patients who meet all of the following criteria: first-line treatment
with FOLFIRINOX, ECOG PS 0–1, relatively favorable comorbidity profile,
and patient preference and support system for aggressive medical
therapy (Moderate Recommendation; IC-B-L).
Recommendation 3.2
➤ Fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan
can be offered as second-line therapy for patients who meet all of the
following criteria: first-line treatment with gemcitabine plus NAB-
paclitaxel, ECOG PS 0–1, relatively favorable comorbidity profile,
patient preference and support system for aggressive medical therapy,
and chemotherapy port and infusion pump management (Moderate
Recommendation; IC-B-L).
Recommendation 3.3
➤ Gemcitabine or fluorouracil can be considered as second-line therapy
for patients who have either an ECOG PS 2 or a comorbidity profile that
precludes more-aggressive regimens and who wish to pursue cancer-
directed therapy (Moderate Recommendation; IC-B-L).
