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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.
    • Neoadjuvant:
      • 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.