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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide

Metastatic pancreatic cancer

Metastatic pancreatic cancer

Guide 16

shows the first-line treatment options for

metastatic pancreatic cancer. First-line treatment

is the first treatment or set of treatments given

to control the cancer. First-line treatment options

include a clinical trial, chemotherapy, targeted

therapy, and/or supportive care.

Symptom control

Before beginning treatment for the cancer, your

doctor will first give treatment for symptoms such

as jaundice. Jaundice is a yellowing of the skin and

eyes caused by a buildup of bilirubin in the body.

Bilirubin is a yellow-brown substance in bile. It is a

digestive fluid made in the liver.

A tumor in the pancreas can cause jaundice by

blocking the bile duct that drains bilirubin out of the

liver. To relieve symptoms of jaundice, your doctors

will place a stent in the bile duct (typically by ERCP)

to relieve the blockage in your bile duct. You will

often be given antibiotic drugs along with the stent,

especially if you have signs of cholangitis (bile duct

infection) such as fevers or chills.

You will not need a stent if you had a biliary bypass

during a previous surgery or laparoscopy.

Performance status rating

Which first-line treatment option 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 you

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.

Guide 16. First-line treatment

Performance status rating First-line treatment

If jaundice,

metal stent



Good performance status


• Clinical trial (preferred)


• Chemotherapy


Poor performance status


• Chemotherapy (one drug only)


• Radiation for palliative care


• Other palliative and best supportive care