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NCCN Guidelines and Compendium Updated
NCCN Flash Update sent April 10, 2013
NCCN has published updates to the NCCN Guidelines® and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Pancreatic Adenocarcinoma. These NCCN Guidelines are currently available as Version 1.2013.
- An introductory statement was added to the Guidelines: "Decisions about diagnostic management and resectability should involve multidisciplinary consultation at a high-volume center with reference to appropriate imaging studies."
- Borderline Resectable, No Metastases, Planned Neoadjuvant Therapy (PANC-4):
- Planned neoadjuvant therapy for patients with borderline resectable disease was changed from a category 2B to a category 2A recommendation.
- "Consider" was added to staging laparoscopy for the workup of patients with borderline resectable disease and planned neoadjuvant therapy. This recommendation was changed from a category 2B to a category 2A.
- Post-Operative Adjuvant Treatment (PANC-6)
- Following baseline pretreatment, pathways for "No prior neoadjuvant therapy" and "Prior neoadjuvant therapy" were added.
- No prior neoadjuvant therapy: "or continuous infusion 5-FU" with or without chemoradiation was added as an adjuvant treatment option.
- Prior neoadjuvant therapy: "Consider additional chemotherapy" was added as an adjuvant treatment option.
- Locally Advanced, Unresectable (PANC-8)
- For patients with locally advanced unresectable disease, under treatment following capecitabine, "or continuous infusion 5-FU (category 2B)" was added.
- Footnote "t", "Patients with a significant response to chemoradiation may be considered for surgical resection" was modified: "although there is no definitive evidence at this time to support this intervention" was removed.
- Metastatic Disease (PANC-9)
- "Gemcitabine + nab-paclitaxel (category 1)" was added as a treatment option for patients with metastatic disease.
- "RT for severe pain refractory to narcotic therapy" was added to salvage therapy for patients with metastatic disease.
- Criteria Defining Resectability Status (PANC-B)
- For tumors considered localized and clearly resectable, the following criteria was modified:
- No radiographic evidence of superior mesenteric vein (SMV) or portal vein (PV) abutment, distortion, tumor thrombus, or venous encasement.
- For tumors considered borderline resectable, the following criteria was modified:
- Venous involvement of the SMV or PV demonstrating tumor abutment with impingement and narrowing of the lumen, encasement of the SMV/portal vein but without encasement of the nearby arteries, or short-segment venous occlusion resulting from either tumor thrombus or encasement but with suitable vessel proximal and distal to the area of vessel involvement, allowing for safe resection and r reconstruction with distortion or narrowing of the vein or occlusion of the vein with suitable vessel proximal and distal, allowing for safe resection and replacement.
- Principles of Chemotherapy (PANC-G)
- Acceptable chemotherapy combinations for patients with metastatic disease and good performance status:
- Gemcitabine + nab-paclitaxel was changed from a category 2B to a category 1.
- A footnote was added to gemcitabine + erlotinib: "Although this combination significantly improved survival, the actual benefit was small, suggesting that only a subset of patients benefit."
- Acceptable monotherapy options for patients with metastatic disease and poor performance status:
- "or continuous infusion 5-FU" was added.
- The following statement was modified: "Although there is insufficient evidence to recommend specific neoadjuvant regimens, most published neoadjuvant regimens incorporate chemoradiation although chemotherapy alone is currently being evaluated."
- The Discussion and Reference sections have been updated to reflect the changes in the algorithm.
For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®,and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.
To view the NCCN Guidelines for Patients®, please visit NCCN.com.
To access free NCCN Guidelines mobile apps for iPhone and Android, visit NCCN.org/mobile.
Now Available! The Virtual Library of NCCN Guidelines are now formatted for iPad and Android. Visit NCCN.org/mobile/tablet.asp.