Recommendation 3.4
➤ No data are available to recommend third-line (or greater) therapy with
a cytotoxic agent. Clinical trial participation is encouraged (Moderate
Recommendation; IC-B-L).
Palliative Care
Recommendation 4.1
➤ Patients with metastatic pancreatic cancer should have a full
assessment of symptom burden, psychological status, and social
supports as early as possible, preferably at the first visit. In most cases,
this assessment will indicate a need for a formal palliative care consult
and services (Strong Recommendation; EB-B-I).
Pain And Symptom Relief
Recommendation 5.1
➤ Patients with metastatic pancreatic cancer should be offered aggressive
treatment of the pain and symptoms of the cancer and/or the cancer-
directed therapy (Strong Recommendation; EB-B-I).
Follow-Up
Recommendation 6.1
➤ For patients on active cancer-directed therapy outside a clinical trial,
imaging to assess first response should be offered at 2–3 months
from the initiation of therapy. CT scans with contrast are the preferred
modality. Thereafter, clinical assessment, conducted frequently during
visits for cancer-directed therapy, should supplant imaging assessment.
The routine use of positron emission tomography scans for the
management of patients with pancreatic cancer is NOT recommended.
CA19-9 is not considered an optimal substitute for imaging for the
assessment of treatment response (Strong Recommendation; IC-B-L).
Recommendation 6.2
➤ No data exist on the duration of cancer-directed therapy. An ongoing
discussion of goals of care and assessment of treatment response and
tolerability should guide decisions to continue or hold/terminate cancer-
directed therapy (Strong Recommendation; IC-B-L).
