NCCN Guidelines Insights: Pancreatic Adenocarcinoma, Version 1.2019

Featured Updates to the NCCN Guidelines

Restricted access

The NCCN Guidelines for Pancreatic Adenocarcinoma discuss the diagnosis and management of adenocarcinomas of the exocrine pancreas and are intended to assist with clinical decision-making. These NCCN Guidelines Insights discuss important updates to the 2019 version of the guidelines, focusing on postoperative adjuvant treatment of patients with pancreatic cancers.

Provided content development and/or authorship assistance.

  • 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34.

  • 2.

    Eheman C, Henley SJ, Ballard-Barbash R, . Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012;118:2338–2366.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Simard EP, Ward EM, Siegel R, . Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin 2012;62:118–128.

  • 4.

    Smith BD, Smith GL, Hurria A, . Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009;27:2758–2765.

  • 5.

    StatBite. U.S. pancreatic cancer rates. J Natl Cancer Inst 2010;102:1822.

  • 6.

    Worni M, Guller U, White RR, . Modest improvement in overall survival for patients with metastatic pancreatic cancer: a trend analysis using the Surveillance, Epidemiology, and End Results registry from 1988 to 2008. Pancreas 2013;42:1157–1163.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Saad AM, Turk T, Al-Husseini MJ, . Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer 2018;18:688.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    White RR, Lowy AM. Clinical management: resectable disease. Cancer J 2017;23:343–349.

  • 9.

    Wu W, He J, Cameron JL, . The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol 2014;21:2873–2881.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Neoptolemos JP, Stocken DD, Friess H, . A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Neoptolemos JP, Stocken DD, Bassi C, . Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 2010;304:1073–1081.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Oettle H, Post S, Neuhaus P, . Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007;297:267–277.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Regine WF, Winter KA, Abrams RA, . Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008;299:1019–1026.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Neoptolemos JP, Palmer DH, Ghaneh P, . Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017;389:1011–1024.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Conroy T, Hammel P, Hebbar M, . FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 2018;379:2395–2406.

  • 16.

    Quiros RM, Brown KM, Hoffman JP. Neoadjuvant therapy in pancreatic cancer. Cancer Invest 2007;25:267–273.

  • 17.

    Heinrich S, Lang H. Neoadjuvant therapy of pancreatic cancer: definitions and benefits. Int J Mol Sci 2017;18:pii: E1622.

  • 18.

    Mokdad AA, Minter RM, Zhu H, . Neoadjuvant therapy followed by resection versus upfront resection for resectable pancreatic cancer: a propensity score matched analysis. J Clin Oncol 2017;25:515–522.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    de Geus SW, Eskander MF, Bliss LA, . Neoadjuvant therapy versus upfront surgery for resected pancreatic adenocarcinoma: a nationwide propensity score matched analysis. Surgery 2017;161:592–601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Shubert CR, Bergquist JR, Groeschl RT, . Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: an intention to treat analysis of the National Cancer Database. Surgery 2016;160:1080–1096.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Nurmi A, Mustonen H, Parviainen H, . Neoadjuvant therapy offers longer survival than upfront surgery for poorly differentiated and higher stage pancreatic cancer. Acta Oncol 2018;57:799–806.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Tienhoven GV, Versteijne E, Suker M, . Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC-1): a randomized, controlled, multicenter phase III trial [abstract]. J Clin Oncol 2018;36(Suppl):Abstract LBA4002.

    • Search Google Scholar
    • Export Citation
  • 23.

    Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;120:899–903.

  • 24.

    Klinkenbijl JH, Jeekel J, Sahmoud T, . Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776–782; discussion 782–784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Smeenk HG, van Eijck CHJ, Hop WC, . Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg 2007;246:734–740.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Garofalo MC, Abrams RA, Regine WF. Adjuvant therapy for pancreatic cancer: no ‘definite’ standard. Oncology 2007;21:726–730.

  • 27.

    Regine WF, Winter KA, Abrams R, . Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U.S. Intergroup/RTOG 9704 phase III trial. Ann Surg Oncol 2011;18:1319–1326.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Neoptolemos JP, Stocken DD, Dunn JA, . Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–768.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Herman JM, Swartz MJ, Hsu CC, . Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 2008;26:3503–3510.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Corsini MM, Miller RC, Haddock MG, . Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005). J Clin Oncol 2008;26:3511–3516.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Hsu CC, Herman JM, Corsini MM, . Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol 2010;17:981–990.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Butturini G, Stocken DD, Wente MN, . Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 2008;143:75–83; discussion 83.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Redmond KJ, Wolfgang CL, Sugar EA, . Adjuvant chemoradiation therapy for adenocarcinoma of the distal pancreas. Ann Surg Oncol 2010;17:3112–3119.

  • 34.

    Stocken DD, Büchler MW, Dervenis C, . Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005;92:1372–1381.

  • 35.

    Merchant NB, Rymer J, Koehler EA, . Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits? J Am Coll Surg 2009;208:829–838;discussion 838–841.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Crane CH, Ben-Josef E, Small W Jr. Chemotherapy for pancreatic cancer. N Engl J Med 2004;350:2713–2715;author reply 2713–2715.

  • 37.

    Koshy MC, Landry JC, Cavanaugh SX, . A challenge to the therapeutic nihilism of ESPAC-1. Int J Radiat Oncol Biol Phys 2005;61:965–966.

  • 38.

    Morris SL, Beasley M, Leslie M. Chemotherapy for pancreatic cancer. N Engl J Med 2004;350:2713–2715;author reply 2713–2715.

  • 39.

    Van Laethem JL, Hammel P, Mornex F, . Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase II study. J Clin Oncol 2010;28:4450–4456.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Schmidt J, Abel U, Debus J, . Open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma. J Clin Oncol 2012;30:4077–4083.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Ren F, Xu YC, Wang HX, . Adjuvant chemotherapy, with or without postoperative radiotherapy, for resectable advanced pancreatic adenocarcinoma: continue or stop? Pancreatology 2012;12:162–169.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Liao WC, Chien KL, Lin YL, . Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 2013;14:1095–1103.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Kooby DA, Gillespie TW, Liu Y, . Impact of adjuvant radiotherapy on survival after pancreatic cancer resection: an appraisal of data from the national cancer data base. Ann Surg Oncol 2013;20:3634–3642.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Morganti AG, Falconi M, van Stiphout RG, . Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. Int J Radiat Oncol Biol Phys 2014;90:911–917.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Burris HA III, Moore MJ, Andersen J, . Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403–2413.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Oettle H, Neuhaus P, Hochhaus A, . Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 2013;310:1473–1481.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Sinn M, Bahra M, Liersch T, . CONKO-005: adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: a multicenter randomized phase III trial. J Clin Oncol 2017;35:3330–3337.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Valle JW, Palmer D, Jackson R, . Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol 2014;32:504–512.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Conroy T, Hammel P, Hebbar M, . Unicancer GI PRODIGE 24/CCTG PA.6 trial: a multicenter international randomized phase III trial of adjuvant mFOLFIRINOX versus gemcitabine (gem) in patients with resected pancreatic ductal adenocarcinomas [abstract] J Clin Oncol 2018;36(Suppl):Abstract LBA4001.

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 5153 5154 423
PDF Downloads 1655 1655 130
EPUB Downloads 0 0 0