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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Treatment guide


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 a fluoropyrimidine-based regimen before.

Lastly, radiation therapy may be given if you have

severe pain not helped by pain medications.

If second-line treatment doesn’t stop the cancer

from growing or spreading, then you have two more

treatment options. One option is to receive the

best supportive care. Supportive care, also called

palliative care, is a treatment focused on symptom

control and improvement of quality of life. The other

option is to join a clinical trial.

If you have a poor performance status after

first-line treatment, then best supportive care is

recommended. See Part 4 for more information on

supportive care.




Cancer tests are used to find cancer, plan

treatment, and check how well treatment is




When cancer is only in the pancreas, surgery

may be a treatment option.



If you have a borderline resectable pancreatic

cancer, your doctor may plan to give you

treatment before surgery. This is called

neoadjuvant treatment.



First-line treatment is the first treatment or set

of treatments given to control the cancer.



Second-line treatment is the next set of

treatments given when the first or previous

treatments failed to stop cancer growth.



Before beginning treatment for the cancer, your

doctor will first give treatment for symptoms

such as jaundice.



Your performance status rating is a very

important factor when choosing the best

treatment for you.