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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide Locally advanced unresectable pancreatic cancer

Guide 15

shows the second-line treatment options

recommended for locally advanced unresectable

pancreatic cancer. Second-line treatment is the next

set of treatments given when the first or previous

treatments failed to stop cancer growth.

Performance status rating

Which treatment is recommended for you depends

on your health status rating, also called performance

status. Your performance status is a rating by

your doctor based on your overall health, cancer

symptoms, and ability to do daily activities. Good

performance status means that your overall health

is good and you’re able to continue doing all of your

regular daily activities very well. You also have very

few or very mild symptoms of the cancer and you’re

able to eat well. Poor performance status means that

your overall health is poor. You aren’t able to do your

regular daily activities well and your are suffering

from a number of cancer symptoms.

Your performance status rating is a very important

factor when choosing the best treatment for you. This

is because patients with a better performance status

are able to tolerate treatments with higher risks of

side effects. Your doctor should explain all of the

risks and possible side effects of the treatments you


If you have a poor performance status after first-line

treatment, then supportive care is recommended

when the tumor continues to grow. If you have a

good performance status after first-line treatment,

then you may receive second-line treatment.

Second-line treatment

If you have a good performance status after first-

line treatment, there are 4 main options for second-

line treatment. The preferred option is to receive

treatment within a clinical trial. The next two options

depend on the type of chemotherapy you had before.

Fluoropyrimidine-based chemotherapy is an option

if you had a gemcitabine-based regimen before.

Likewise, gemcitabine-based therapy is an option

if you had fluoropyrimidine-based regimen before.

Lastly, chemoradiation is another possible option.

Chemoradiation is only recommended if you haven’t

had it before and if cancer has only progressed in the

pancreas, the primary site of the disease.

If you have a poor performance status after second-

line treatment, then the next option is best supportive

care. Supportive care, also called palliative care, is

a treatment focused on symptoms and improvement

of quality of life. See Part 4 from more information on

supportive care.

Next steps

This next section describes the tests and treatments

recommended for cancer that has spread outside the

pancreas to other sites or organs in the body. This

is called metastatic pancreatic cancer. Metastatic

tumors are formed when cancer cells spread through

the blood or lymphatic system to sites or organs that

are far away from the pancreas.