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By 2020, pancreatic cancer is expected to be the second most common cause of cancer-related death, exceeded only by lung cancer. During her presentation at the NCCN 22nd Annual Conference, Dr. Margaret Tempero offered an update on the current state of systemic treatment of pancreatic cancer, focusing on resectable/borderline resectable, locally advanced, and metastatic disease.

Outcomes for pancreatic cancer are becoming less discouraging with the refinement of molecular profiling, both germline and somatic, and beneficial effects seen with adjuvant chemotherapy. The NCCN Guidelines for Pancreatic Adenocarcinoma reflect these advances, and recommend that clinicians consider germline testing for all patients with pancreatic cancer and consider a molecular analysis for those with metastatic disease. The guidelines further recommend that clinicians consider adjuvant therapy with modified FOLFIRINOX (leucovorin/5-FU/irinotecan/oxaliplatin) for patients who are able to tolerate it.

Although we are “winning the war against cancer,” pancreatic malignancies are expected to be the most common cause of cancer-related death by 2040. Several systemic therapies, such as oxaliplatin + irinotecan/fluorouracil/leucovorin (FOLFIRINOX) and gemcitabine + nab-paclitaxel, have shown activity in the adjuvant and neoadjuvant settings. The current NCCN Guidelines reflect the most up-to-date, evidence-based data relating to the evaluation and management of pancreatic adenocarcinoma. They were recently updated to recommend germline testing for any patient with pancreatic cancer and molecular analysis of any metastatic pancreatic tumor.