# Metastatic Pancreatic Cancer: ASCO Guideline Update

Source: https://onco.cc/key-papers/paper-asco-metastatic-pancreatic-cancer-guideline-update-jco-2020/  
OnCo record `paper-asco-metastatic-pancreatic-cancer-guideline-update-jco-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2020 American guideline update that told doctors to test every treatment-eligible patient with metastatic pancreatic cancer for inherited BRCA changes, mismatch repair deficiency and TRK fusions, because each now had a drug attached.

## Summary

ASCO convened an Expert Panel and systematic review to update its metastatic pancreatic cancer guideline for therapy after first-line treatment. One randomised trial of olaparib versus placebo (POLO), one report on phase 1 and 2 studies of larotrectinib and one on entrectinib met the inclusion criteria. New or updated recommendations cover germline and somatic testing for microsatellite instability or mismatch repair deficiency, BRCA mutations and TRK alterations in all treatment-eligible patients, to select patients for pembrolizumab, olaparib, larotrectinib or entrectinib, or for trials. The panel continued to endorse the 2018 recommendations for second-line chemotherapy (gemcitabine plus nab-paclitaxel after FOLFIRINOX; fluorouracil plus nanoliposomal irinotecan after gemcitabine-based therapy) and for palliative care and follow-up.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Journal of Clinical Oncology
- Year: 2020
- DOI: 10.1200/JCO.20.01364
- Authors: Sohal DPS, Kennedy EB, Cinar P, et al.
- Findings: Three reports informed the update: POLO (olaparib versus placebo), larotrectinib phase 1 and 2, entrectinib phase 1 and 2.; Germline and somatic testing for mismatch repair deficiency, BRCA mutations and TRK alterations is recommended for all treatment-eligible patients.; Second-line chemotherapy, follow-up and palliative care recommendations from 2018 were carried forward.
- What it means: The document that made biomarker testing part of routine pancreatic cancer care in the United States; the 2018 version it built on fixed the second-line chemotherapy sequence still used in most guidelines.
- Caveats: Predates the KRAS G12C inhibitors, NALIRIFOX and daraxonrasib.; The recommended targeted drugs each apply to a few percent of patients.

## Sources

- J Clin Oncol 2020: https://doi.org/10.1200/JCO.20.01364
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32755482/
- The 2018 update this built on (J Clin Oncol 2018): https://doi.org/10.1200/JCO.2018.78.9636
- ASCO gastrointestinal cancer guidelines: https://ascopubs.org/topics/asco-guidelines/gastrointestinal-cancer

## Connected records

- key papers: [Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial](https://onco.cc/key-papers/paper-napoli-1-nanoliposomal-irinotecan-lancet-2016/), [POLO: maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer](https://onco.cc/key-papers/paper-polo-olaparib-maintenance-gbrca-pancreatic-nejm-2019/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- drugs: [Entrectinib](https://onco.cc/drugs/entrectinib/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [Olaparib](https://onco.cc/drugs/olaparib/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/)
- trials: [POLO](https://onco.cc/trials/polo/)
- people: [Eileen M. O'Reilly](https://onco.cc/people/eileen-oreilly/), [Thierry Conroy](https://onco.cc/people/thierry-conroy/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)

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