ASCO 2018 Clinical Practice Guideline Update On Metastatic P
The American Society of Clinical Oncology (ASCO) has recently released updated recommendations that incorporate new evidence related to second-line therapy for patients with metastatic pancreatic cancer who progressed on or experienced intolerable toxicity during first-line therapy. The current recommendations are an update to 2016 ASCO guideline aimed at clinical decision making in metastatic pancreatic cancer.

The key recommendations are:-
• For second-line therapy, gemcitabine plus nanoparticle albumin-bound paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin), an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1, and a favourable comorbidity profile

• Fluorouracil plus nanoliposomal irinotecan can be offered to patients with first-line Rx with gemcitabine plus NAB-paclitaxel, an ECOG PS of 0 to 1, and a favourable comorbidity profile

• Fluorouracil plus irinotecan or fluorouracil plus oxaliplatin may be offered when there is a lack of availability of fluorouracil plus nanoliposomal irinotecan

• Offer gemcitabine or fluorouracil to patients with either an ECOG PS of 2 or a comorbidity profile that precludes other regimens

• Testing select patients for mismatch repair deficiency or microsatellite instability is recommended

• Pembrolizumab for patients with mismatch repair deficiency or high microsatellite instability tumors

• Routine testing for dMMR (deficiency in mismatch repair) or MSI-H (high microsatellite instability) is recommended, using IHC, PCR, or NGS (next-generation sequencing) for patients who are considered to be candidates for checkpoint inhibitor therapy

• PD-1 immune checkpoint inhibitor pembrolizumab is recommended as second-line Rx for patients who have tested positive for dMMR or MSI-H

• Fluorouracil plus nanoliposomal irinotecan, or fluorouracil plus irinotecan where the former combination is unavailable, is preferred as second-line Rx for patients who meet all of the following criteria: first-line treatment with gemcitabine plus NAB-paclitaxel, an ECOG PS of 0 to 1, a relatively favourable comorbidity profile, patient preference and a support system for aggressive medical therapy, and access to chemotherapy port and infusion pump management services

• Fluorouracil plus oxaliplatin may be considered as second-line Rx for patients who meet all of the following criteria: first-line treatment with gemcitabine plus NAB-paclitaxel, an ECOG PS of 0 to 1, a relatively favourable comorbidity profile, patient preference and a support system for aggressive medical therapy, and access to chemotherapy port and infusion pump management services



About ASCO
The American Society of Clinical Oncology (ASCO) is a professional organization representing physicians of all oncology sub-specialties who care for people with cancer. Founded in 1964, it offers several educational resources for cancer physicians and other health care professionals in the field of clinical oncology. These resources include scientific meetings, educational conferences, professional workshops, and special symposia on issues of particular relevance and importance to oncologists and researchers.


Note: This list is a brief compilation of some of the key recommendations included in the Guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: http://ascopubs.org/doi/pdf/10.1200/JCO.2018.78.9636
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