NCCN Guidelines for Patients
Pancreatic Cancer, Version 1.2017
Treatment guide Locally advanced unresectable pancreatic cancer
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.
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
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.