Borderline resectable pancreatic ductal adenocarcinoma: lines of therapy
5 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Neoadjuvant chemotherapy | Modified FOLFIRINOX for two to four months in fit patients, gemcitabine plus nab-paclitaxel otherwise; restage with CT and CA 19-9 before deciding on surgery (PREOPANC, ESPAC-5). | NCCN Guidelines: Pancreatic Adenocarcinoma | 83 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Radiotherapy after chemotherapy | Optional; conventional chemoradiation or stereotactic radiotherapy to secure an arterial margin in selected patients, with ALLIANCE A021501 as the caution against routine use. | NCCN Guidelines: Pancreatic Adenocarcinoma | 82 | |
| All comers | Progression during neoadjuvant therapy | Manage as locally advanced or metastatic disease; switch chemotherapy backbone, RAS inhibitor trials, biliary stenting for jaundice. | NCCN Guidelines: Pancreatic Adenocarcinoma | 85 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Surgery | Pancreatoduodenectomy or distal pancreatectomy with venous resection and reconstruction where needed, arterial resection only in specialist centres; proceed on stable or improved disease with falling CA 19-9. | NCCN Guidelines: Pancreatic Adenocarcinoma | 40 | |
| All comers | After surgery | Complete six months of chemotherapy in total, usually with the regimen the tumour responded to. | NCCN Guidelines: Pancreatic Adenocarcinoma | 90 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.