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(NCCN Guidelines®) Pancreatic Adenocarcinoma Version 1.2015 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Pancreatic Adenocarcinoma Version 1.2015 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 1.2015, 12/04/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 12/28/2014 4:07:39 AM. For personal use only. Not approved for distribution. Copyright © 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2015 Panel Members NCCN Guidelines Index Pancreatic Table of Contents Pancreatic Adenocarcinoma Discussion * Margaret A. Tempero, MD/Chair †‡ Joseph Herman, MD, MSc § Eileen M. O’Reilly, MD Ϸ UCSF Helen Diller Family The Sidney Kimmel Comprehensive Memorial Sloan Kettering Cancer Center Comprehensive Cancer Center Cancer Center at Johns Hopkins Jorge Obando, MD ¤ Mokenge P. Malafa, MD/Vice Chair ¶ John P. Hoffman, MD ¶ Duke Cancer Institute Moffitt Cancer Center Fox Chase Cancer Center Martha B. Pitman, MD ≠ Horacio Asbun, MD ¶ Andrew H. Ko, MD † Massachusetts General Hospital Cancer Center Mayo Clinic Cancer Center UCSF Helen Diller Family Comprehensive Cancer Center Sushanth Reddy, MD ¶ Stephen W. Behrman, MD ¶ University of Alabama at Birmingham The University of Tennessee Srinadh Komanduri, MD ¤~ Comprehensive Cancer Center Health Science Center Robert H. Lurie Comprehensive Cancer Center of Northwestern University Aaron R. Sasson, MD ¶ Al B. Benson III, MD † Fred & Pamela Buffett Cancer Center at Robert H. Lurie Comprehensive Cancer Albert Koong, MD, PhD § The Nebraska Medical Center Center of Northwestern University Stanford Cancer Institute Colin D. Weekes, MD, PhD † Charles Cha, MD ¶ Andrew M. Lowy, MD ¶ University of Colorado Cancer Center Yale Cancer Center/ UC San Diego Moores Cancer Center Smilow Cancer Hospital Robert A. Wolff, MD ¤† Wen Wee Ma, MD †‡Þ The University of Texas E. Gabriela Chiorean, MD † Roswell Park Cancer Institute MD Anderson Cancer Center Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Nipun B. Merchant, MD ¶ Brian M. Wolpin, MD, MPH † Vanderbilt-Ingram Cancer Center Dana-Farber/Brigham and Women’s Vincent Chung, MD † Cancer Center City of Hope Comprehensive Cancer Center Sean J. Mulvihill, MD ¶ Huntsman Cancer Institute Steven J. Cohen, MD † at the University of Utah NCCN Fox Chase Cancer Center Jennifer Burns Peter Muscarella II, MD ¤¶ Deborah Freedman-Cass, PhD Brian Czito, MD § The Ohio State University Comprehensive Duke Cancer Institute Cancer Center - James Cancer Hospital and Solove Research Institute Anitra Engebretson ¥ ¤ Gastroenterology Pancreatic Cancer Action Network (PanCAN) Eric K. Nakakura, MD ¶ ¶ Surgery/surgical oncology UCSF Helen Diller Family § Radiotherapy/radiation oncology Mary Feng, MD § Comprehensive Cancer Center † Medical oncology Unversity of Michigan ‡ Hematology/hematology oncology Comprehensive Cancer Center Þ Internal medicine ~Interventional radiology William G. Hawkins, MD ¶ Siteman Cancer Center at Barnes-Jewish Hospital ≠ Pathology and Washington University School of Medicine Continue ¥ Patient advocacy * Writing Committee Member NCCN Guidelines Panel Disclosures Version 1.2015, 12/04/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines®and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 12/28/2014 4:07:39 AM. For personal use only. Not approved for distribution. Copyright © 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2015- Sub-Committee NCCN Guidelines Index Pancreatic Table of Contents Pancreatic Adenocarcinoma Discussion Pancreatic Adenocarcinoma Panel: Imaging Subcommittee NCCN gratefully acknowledges the following subcommittee members for their contributions during the update of the Principles of Diagnosis, Imaging and Staging (PANC-A) and Criteria Defining Resectability Status (PANC-B) in Version 1.2015 of the NCCN Guidelines for Pancreatic Adenocarcinoma: Elliot K. Fishman, MD/Lead ф The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Mahmoud Al-Hawary, MD ф University of Michigan Comprehensive Cancer Center Isaac R. Francis, MD ф University of Michigan Comprehensive Cancer Center Nipun B. Merchant, MD ¶ Vanderbilt-Ingram Cancer Center Dushyant V. Sahani, MD ф Massachusetts General Hospital Cancer Center Eric Tamm, MD ф The University of Texas MD Anderson Cancer Center ¶ Surgery/surgical oncology ф Diagnostic radiology Continue NCCN Guidelines Panel Disclosures Version 1.2015, 12/04/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines®and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 12/28/2014 4:07:39 AM. For personal use only. Not approved for distribution. Copyright © 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2015- Table of Contents NCCN Guidelines Index Pancreatic Table of Contents Pancreatic Adenocarcinoma Discussion NCCN Pancreatic Adenocarcinoma Panel Members Summary of Guidelines Updates Clinical Trials: NCCN believes that Introduction the best management for any cancer Clinical Suspicion of Pancreatic Cancer or patient is in a clinical trial. Evidence of Dilated Pancreatic and/or Bile Duct (PANC-1) Participation in clinical trials is especially encouraged. No Metastatic Disease on Physical Exam and by Imaging (PANC-2) Resectable, Workup, Treatment (PANC-3) To find clinical trials online at NCCN Member Institutions, click here: Borderline Resectable, No Metastases, Planned Neoadjuvant Therapy (PANC-4) nccn.org/clinical_trials/physician.html. Borderline Resectable, No Metastases, Planned Resection (PANC-5) NCCN Categories of Evidence and Postoperative Adjuvant Treatment (PANC-6) Consensus: All recommendations Locally Advanced, Unresectable (PANC-7) are category 2A unless otherwise Metastatic Disease (PANC-9) specified. Recurrence After Resection (PANC-10) See NCCN Categories of Evidence Principles of Diagnosis, Imaging, and Staging (PANC-A) and Consensus. Criteria Defining Resectability Status (PANC-B) Principles of Surgical Technique (PANC-C) Pathologic Analysis: Specimen Orientation, Histologic Sections, and Reporting (PANC-D) Principles of Palliation and Supportive Care (PANC-E) Principles of Radiation Therapy (PANC-F) Principles of Chemotherapy (PANC-G) American Joint Committee on Cancer (AJCC) TNM Staging of Pancreatic Cancer (2010) (ST-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. © 2014. Version 1.2015, 12/04/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines®and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Alexandre Ferreira on 12/28/2014 4:07:39 AM. For personal use only. Not approved for distribution. Copyright © 2014 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2015- Updates NCCN Guidelines Index Pancreatic Table of Contents Pancreatic Adenocarcinoma Discussion Updates in Version 1.2015 of the NCCN Guidelines for Pancreatic Adenocarcinoma from Version 2.2014 include: General PANC-8 • “Duodenal bypass” was changed to “gastrojejunostomy” throughout. • Under treatment, “fluoropyrimidine + oxaliplatin (category 2B)” was • “Open celiac plexus block” was changed to “celiac plexus neurolysis” added for consistency with the acceptable chemotherapy combinations throughout. listed on PANC-G (1 of 3) for patients with good performance status • “Short metal stent” and “stent” were changed to “self-expanding metal and locally advanced or metastatic disease. (Also on PANC-9) stent” throughout. • Footnote “u” was revised: “Based on preliminary data from the LAP-07 • “Salvage therapy” was changed to “second-line therapy” throughout. trial, there is no clear survival benefit with the addition of conventional Introduction chemoradiation following gemcitabine monotherapy. Chemoradiation • The introduction statement was clarified: “...at a high-volume center with may improve local control and delay the need for resumption therapy. reference to use of appropriate imaging studies.” (Huguet F, Hammel P, Vernerey D, et al. Impact of chemoradiation on local control and time without treatment in patients with locally PANC-1 advanced pancreatic cancer included in the international phase III LAP • Under workup, MRI was removed: “Pancreatic protocol CT or MRI (See 07 study. J Clin Oncol 2014; 32:5s. Abstract 4001.) (Also for footenote PANC-A).”
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