TY - JOUR
T1 - Locally advanced, unresectable pancreatic cancer
T2 - American society of clinical oncology clinical practice guideline
AU - Balaban, Edward P.
AU - Mangu, Pamela B.
AU - Khorana, Alok A.
AU - Shah, Manish A.
AU - Mukherjee, Somnath
AU - Crane, Christopher H.
AU - Javle, Milind M.
AU - Eads, Jennifer R.
AU - Allen, Peter
AU - Ko, Andrew H.
AU - Engebretson, Anitra
AU - Herman, Joseph M.
AU - Strickler, John H.
AU - Benson, Al B.
AU - Urba, Susan
AU - Yee, Nelson S.
N1 - Publisher Copyright:
© 2016 by American Society of Clinical Oncology.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Purpose: To provide evidence-based recommendations to oncologists and others for treatment of patients with locally advanced, unresectable pancreatic cancer. Methods: American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts and conducted a systematic review of the literature from January 2002 to June 2015. Outcomes included overall survival, disease-free survival, progression-free survival, and adverse events. Results: Twenty-six randomized controlled trials met the systematic review criteria. Recommendations: A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. The goals of care, patient preferences, psychological status, support systems, and symptoms should guide decisions for treatments. A palliative care referral should occur at first visit. Initial systemic chemotherapy (6months)with a combination regimen is recommended for most patients (for some patients radiation therapy may be offered up front) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile. There is no clear evidence to support one regimen over another. The gemcitabinebased combinations and treatments recommended in themetastatic setting (eg, fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel) have not been evaluated in randomized controlled trials involving locally advanced, unresectable pancreatic cancer. If there is local disease progression after induction chemotherapy, without metastasis, then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile. If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities, radiation therapy may be offered as an alternative. Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline. Follow-up visits every 3 to 4months are recommended.
AB - Purpose: To provide evidence-based recommendations to oncologists and others for treatment of patients with locally advanced, unresectable pancreatic cancer. Methods: American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts and conducted a systematic review of the literature from January 2002 to June 2015. Outcomes included overall survival, disease-free survival, progression-free survival, and adverse events. Results: Twenty-six randomized controlled trials met the systematic review criteria. Recommendations: A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. The goals of care, patient preferences, psychological status, support systems, and symptoms should guide decisions for treatments. A palliative care referral should occur at first visit. Initial systemic chemotherapy (6months)with a combination regimen is recommended for most patients (for some patients radiation therapy may be offered up front) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile. There is no clear evidence to support one regimen over another. The gemcitabinebased combinations and treatments recommended in themetastatic setting (eg, fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel) have not been evaluated in randomized controlled trials involving locally advanced, unresectable pancreatic cancer. If there is local disease progression after induction chemotherapy, without metastasis, then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile. If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities, radiation therapy may be offered as an alternative. Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline. Follow-up visits every 3 to 4months are recommended.
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U2 - 10.1200/JCO.2016.67.5561
DO - 10.1200/JCO.2016.67.5561
M3 - Article
C2 - 27247216
AN - SCOPUS:84979520392
SN - 0732-183X
VL - 34
SP - 2654
EP - 2667
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 22
ER -