Pancreatic

Question 1

Management of resectable disease

Answer 1

Surgery
Adjuvant FOLFIRINOX or gem + capecitabine x 6 months

If unfit, consider adjuvant gem
Consider adjuvant gem + cisplatin in patients with BRCA1/2 or PALB2 mutation

Question 2

Management of borderline resectable disease

Answer 2

Consider neoadjuvant chemo with FOLFIRINOX or gem + nab-paclitaxel
Consider staging laparoscopy after neoadjuvant chemo to assess resectability
Consider adjuvant chemo and/or chemoRT after resection

Question 3

Management of locally advanced, unresectable disease

Answer 3

Fit patients: consider 4-6 months induction chemo followed by chemoRT for those who don’t progress
Recommended regimens are folfirinox or gem + abraxane

Unfit patients: palliative single agent chemo, palliative RT, BSC
Chemo options include gem, cape, and 5-FU

Question 4

1st line metastatic treatment

Answer 4

Fit: FOLFIRINOX or gem + abraxane
Unfit: gem, cape, 5-FU

Question 5

Maintenance olaparib indication

Answer 5

Patients with germline BRCA 1/2 mutation who get at least 16 weeks of platinum chemotherapy without progression

Question 6

2nd line or later metastatic treatment options

Answer 6

Gemcitabine +/- abraxane
5-FU +/- irinotecan or oxaliplatin

BRCA 1/2 or PALB2 mutation- gem + cisplatin