Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines.

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 summarize major discussion points from the 2014 NCCN Pancreatic Adenocarcinoma Panel meeting. The panel discussion focused mainly on the management of borderline resectable and locally advanced disease. In particular, the panel discussed the definition of borderline resectable disease, role of neoadjuvant therapy in borderline disease, role of chemoradiation in locally advanced disease, and potential role of newer, more active chemotherapy regimens in both settings.

[1]  B. Hoffman,et al.  Clinical Investigation : Gastrointestinal Cancer Phase 2 Trial of Induction Gemcitabine , Oxaliplatin , and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer , 2022 .

[2]  B. Erickson,et al.  Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: a new treatment paradigm? , 2014, The oncologist.

[3]  A. Ko,et al.  Evolving treatment options for locally advanced unresectable pancreatic ductal adenocarcinoma. , 2014, Journal of the National Comprehensive Cancer Network : JNCCN.

[4]  S. Corrao,et al.  Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: A meta-analytical evaluation of prospective studies , 2012 .

[5]  R. Pietrobon,et al.  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 , 2013, Pancreas.

[6]  J. Cameron,et al.  Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor–vessel relationships , 2013, Journal of Radiation Oncology.

[7]  L. Matrisian,et al.  Pancreatic cancer clinical trials and accrual in the United States. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Edward J. Kim,et al.  A multi‐institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer , 2013, Cancer.

[9]  A. Krasinskas,et al.  Phase II Study of Induction Fixed-Dose Rate Gemcitabine and Bevacizumab Followed by 30 Gy Radiotherapy as Preoperative Treatment for Potentially Resectable Pancreatic Adenocarcinoma , 2013, Annals of Surgical Oncology.

[10]  M. Pichler,et al.  Safety and efficacy of neoadjuvant FOLFIRINOX treatment in a series of patients with borderline resectable pancreatic ductal adenocarcinoma , 2013, Acta oncologica.

[11]  Jeffrey W. Clark,et al.  FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience. , 2013, The oncologist.

[12]  D. Goldstein,et al.  Comparison of chemoradiotherapy (CRT) and chemotherapy (CT) in patients with a locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: Final results of the international phase III LAP 07 study. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  J. Berlin,et al.  Borderline Resectable Pancreatic Cancer: Need for Standardization and Methods for Optimal Clinical Trial Design , 2013, Annals of Surgical Oncology.

[14]  A. Hezel,et al.  Unresectable locally advanced pancreatic cancer: treatment with neoadjuvant leucovorin, fluorouracil, irinotecan, and oxaliplatin and assessment of surgical resectability. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Jeffrey E. Lee,et al.  Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators , 2012, Cancer.

[16]  Ahmedin Jemal,et al.  Annual Report to the Nation on the status of cancer, 1975‐2008, featuring cancers associated with excess weight and lack of sufficient physical activity , 2012, Cancer.

[17]  Jürgen Weitz,et al.  Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer , 2012, Radiation oncology.

[18]  Ahmedin Jemal,et al.  Cancers with increasing incidence trends in the United States: 1999 through 2008 , 2012, CA: a cancer journal for clinicians.

[19]  P. Philip Locally advanced pancreatic cancer: where should we go from here? , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  David Cella,et al.  Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  G. Eslick,et al.  A Systematic Review and Meta-analysis of Survival and Surgical Outcomes Following Neoadjuvant Chemoradiotherapy for Pancreatic Cancer , 2011, Journal of Gastrointestinal Surgery.

[22]  Laura H. Tang,et al.  Downstaging in Pancreatic Cancer: A Matched Analysis of Patients Resected Following Systemic Treatment of Initially Locally Unresectable Disease , 2011, Annals of Surgical Oncology.

[23]  G. Weiss,et al.  Preoperative Capecitabine and Concurrent Radiation for Borderline Resectable Pancreatic Cancer , 2011, Annals of Surgical Oncology.

[24]  H. Friess,et al.  Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. , 2010, JAMA.

[25]  P. Catalano,et al.  Randomized phase II study of gemcitabine plus radiotherapy versus gemcitabine, 5‐fluorouracil, and cisplatin followed by radiotherapy and 5‐fluorouracil for patients with locally advanced, potentially resectable pancreatic adenocarcinoma , 2010, Journal of surgical oncology.

[26]  Tibor Schuster,et al.  Preoperative/Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-analysis of Response and Resection Percentages , 2010, PLoS medicine.

[27]  A. Lowy,et al.  Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer. , 2010, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[28]  H. Ling Chemoradiotherapy in the Management of Locally Advanced Pancreatic Carcinoma:A Qualitative Systematic Review , 2010 .

[29]  Benjamin D Smith,et al.  Future of cancer incidence in the United States: burdens upon an aging, changing nation. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  Kenneth J. Chang,et al.  Pretreatment Assessment of Resectable and Borderline Resectable Pancreatic Cancer: Expert Consensus Statement , 2009, Annals of Surgical Oncology.

[31]  T. Ryan,et al.  Phase I/II Trial of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy and Surgery for Locoregionally Advanced Pancreatic Cancer , 2008, Annals of Surgical Oncology.

[32]  B. Chauffert,et al.  Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. , 2008, Annals of oncology : official journal of the European Society for Medical Oncology.

[33]  A. Benson,et al.  A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer: E4201 , 2008 .

[34]  R. Abrams,et al.  Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. , 2008, JAMA.

[35]  Douglas B. Evans,et al.  Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy , 2007, Cancer.

[36]  M. Saif,et al.  Is there an optimal neoadjuvant therapy for locally advanced pancreatic cancer? , 2007, JOP : Journal of the pancreas.

[37]  E. Touboul,et al.  Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  Peter Neuhaus,et al.  Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. , 2007, JAMA.

[39]  K. Brown,et al.  Neoadjuvant Therapy in Pancreatic Cancer , 2007, Cancer investigation.

[40]  V. Valentini,et al.  Preoperative Chemoradiation and Intra-Operative Radiotherapy for Pancreatic Carcinoma , 2007, Tumori.

[41]  C. Mcginn,et al.  Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas , 2003, Journal of Gastrointestinal Surgery.

[42]  A. Muratore,et al.  Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival , 2006, Annals of Surgical Oncology.

[43]  Jeffrey E. Lee,et al.  Borderline Resectable Pancreatic Cancer: Definitions, Management, and Role of Preoperative Therapy , 2006, Annals of Surgical Oncology.

[44]  N. Girard,et al.  Radiochemotherapy in the management of pancreatic cancer--part I: neoadjuvant treatment. , 2005, Seminars in radiation oncology.

[45]  Helen Hickey,et al.  A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. , 2004, The New England journal of medicine.

[46]  J. Tepper,et al.  Cancer and leukemia group B (CALGB) 89805: phase II chemoradiation trial using gemcitabine in patients with locoregional adenocarcinoma of the pancreas. , 2001, International journal of gastrointestinal cancer.

[47]  E. Paulson,et al.  Neoadjuvant Chemoradiation for Localized Adenocarcinoma of the Pancreas , 2001, Annals of Surgical Oncology.

[48]  W. Bautz,et al.  Preoperative Chemoradiation in Locally Advanced Pancreatic Carcinoma: A Phase II Study , 2000, Oncology Research and Treatment.

[49]  L. Traverso,et al.  Concomitant intraarterial cisplatin, intravenous 5-flourouracil, and split-course radiation therapy for locally advanced unresectable pancreatic adenocarcinoma: a phase II study of the Puget Sound Oncology Consortium (PSOC-703). , 1997, American journal of clinical oncology.

[50]  Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. Gastrointestinal Tumor Study Group. , 1988, Journal of the National Cancer Institute.

[51]  L. Sobin,et al.  TNM Classification of Malignant Tumours , 1987, UICC International Union Against Cancer.

[52]  P. Engstrom,et al.  Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.