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NCCN Announces Updates to Pancreatic Adenocarcinoma Guidelines
New updates to the NCCN Guidelines for Pancreatic Adenocarcinoma were announced on March 12 at the NCCN 14th Annual Conference. Notable additions include updates on when a laparoscopy may be beneficial to patients, clarification on diagnostic imaging protocols, and an overall emphasis on systemic therapy in all disease stages. Pancreatic adenocarcinoma is the second most common cause of death from gastrointestinal cancer.
March 13, 2009
HOLLYWOOD, FL – The National Comprehensive Cancer Network (NCCN) presented important updates to the NCCN Clinical Practice Guidelines in Oncology™ for Pancreatic Adenocarcinoma today at the NCCN 14th Annual Conference. Margaret A. Tempero, MD, of UCSF Helen Diller Family Comprehensive Cancer Center, presented the updated NCCN Guidelines that promoted more individualized management, clarified required diagnostic imaging, and placed increased emphasis on systemic therapy in all disease stages.
The 2009 version of the NCCN Guidelines clarify the recommendations for diagnostic imaging in patients with pancreatic cancer. The panel recommends that imaging should include a pancreatic computed tomography (CT) scan performed according to a defined pancreas protocol, such as triphasic cross-sectional imaging and thin slices, and that PET scan may be considered useful if CT results are equivocal. The panel emphasized that decisions about disease management and resectability should involve close multidisciplinary cooperation.
Also new to the 2009 NCCN Guidelines is the recommendation to consider laparoscopy prior to resection in high-risk (e.g. those with disabling symptoms or equivocal CT findings) patients considered to have resectable disease at presentation. Laparoscopy is also recommended after neoadjuvant therapy in patients with borderline resectable disease, prior to laparotomy.
Another important addition to the NCCN Guidelines is a revised set of criteria based on a consensus of the panel members which defines borderline resectable disease.
Dr. Tempero also provided additional clarification regarding the importance of upfront systemic therapy prior to administration of chemoradiation therapy stating that, “Radiation is important for a subset of patients with local disease only, but systemic chemotherapy should be given first.”
Upfront systemic therapy provides for disease control and allows selection of those patients most likely to benefit from subsequent chemoradiation.
Dr. Tempero also recommended fluorinated pyrimidine-based therapy with oxaliplatin (Eloxatin®, sanofi-aventis) as a second-line option for patients with advanced disease and good performance status based on results of clinical trial that showed a significant survival benefit for patients receiving the combination of therapies.
Dr. Tempero summarized the recommendations for patients with metastatic disease by saying, “Single agent gemcitabine (Gemzar®, Eli Lilly and Company) or selected gemcitabine combinations followed by a fluorinated pyrimidine plus oxaliplatin is the standard of care.”
Of all the gastrointestinal malignancies, pancreatic adenocarcinoma is the second most common cause of death from cancer. The diagnosis of pancreatic cancer is rarely made at an early stage, which is one of the main reasons for failing to achieve a cure in most patients.
Dr. Tempero illustrated this point further during the presentation stating that, “80 percent of patients with pancreatic cancer relapse systematically even with adjuvant therapy” and that “clinicians must keep this in mind as we treat our patients.”