Locally advanced, unresectable pancreatic cancer

American society of clinical oncology clinical practice guideline

Edward P. Balaban, Pamela B. Mangu, Alok A. Khorana, Manish A. Shah, Somnath Mukherjee, Christopher H. Crane, Milind M. Javle, Jennifer R. Eads, Peter Allen, Andrew H. Ko, Anitra Engebretson, Joseph M. Herman, John H. Strickler, Al B. Benson, Susan Urba, Nelson S. Yee

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2654-2667
Number of pages14
JournalJournal of Clinical Oncology
Volume34
Issue number22
DOIs
StatePublished - Aug 1 2016

Fingerprint

Medical Oncology
Pancreatic Neoplasms
Practice Guidelines
Comorbidity
oxaliplatin
irinotecan
Induction Chemotherapy
Radiotherapy
gemcitabine
Palliative Care
Disease-Free Survival
Disease Progression
Randomized Controlled Trials
Patient Care Planning
Therapeutics
Radiation Oncology
Leucovorin
Patient Preference
Radiosurgery
Gastroenterology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Balaban, E. P., Mangu, P. B., Khorana, A. A., Shah, M. A., Mukherjee, S., Crane, C. H., ... Yee, N. S. (2016). Locally advanced, unresectable pancreatic cancer: American society of clinical oncology clinical practice guideline. Journal of Clinical Oncology, 34(22), 2654-2667. https://doi.org/10.1200/JCO.2016.67.5561
Balaban, Edward P. ; Mangu, Pamela B. ; Khorana, Alok A. ; Shah, Manish A. ; Mukherjee, Somnath ; Crane, Christopher H. ; Javle, Milind M. ; Eads, Jennifer R. ; Allen, Peter ; Ko, Andrew H. ; Engebretson, Anitra ; Herman, Joseph M. ; Strickler, John H. ; Benson, Al B. ; Urba, Susan ; Yee, Nelson S. / Locally advanced, unresectable pancreatic cancer : American society of clinical oncology clinical practice guideline. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 22. pp. 2654-2667.
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Balaban, EP, Mangu, PB, Khorana, AA, Shah, MA, Mukherjee, S, Crane, CH, Javle, MM, Eads, JR, Allen, P, Ko, AH, Engebretson, A, Herman, JM, Strickler, JH, Benson, AB, Urba, S & Yee, NS 2016, 'Locally advanced, unresectable pancreatic cancer: American society of clinical oncology clinical practice guideline', Journal of Clinical Oncology, vol. 34, no. 22, pp. 2654-2667. https://doi.org/10.1200/JCO.2016.67.5561

Locally advanced, unresectable pancreatic cancer : American society of clinical oncology clinical practice guideline. / Balaban, Edward P.; Mangu, Pamela B.; Khorana, Alok A.; Shah, Manish A.; Mukherjee, Somnath; Crane, Christopher H.; Javle, Milind M.; Eads, Jennifer R.; Allen, Peter; Ko, Andrew H.; Engebretson, Anitra; Herman, Joseph M.; Strickler, John H.; Benson, Al B.; Urba, Susan; Yee, Nelson S.

In: Journal of Clinical Oncology, Vol. 34, No. 22, 01.08.2016, p. 2654-2667.

Research output: Contribution to journalArticle

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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.

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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.

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