Locally advanced unresectable pancreatic ductal adenocarcinoma: lines of therapy
6 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.
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Induction chemotherapy | Modified FOLFIRINOX or gemcitabine plus nab-paclitaxel for four to six months, with biliary stenting, pancreatic enzyme replacement and pain control alongside. | NCCN Guidelines: Pancreatic Adenocarcinoma | 81 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Progression | Treat as metastatic disease: switch backbone, daraxonrasib after first-line chemotherapy, clinical trials. | NCCN Guidelines: Pancreatic Adenocarcinoma | 85 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Tumour treating fields | Alternating electric fields delivered through skin arrays added to gemcitabine plus nab-paclitaxel (PANOVA-3), approved in 2026. | NCCN Guidelines: Pancreatic Adenocarcinoma | 93 | |
| All comers | Consolidation local therapy | Chemoradiation with capecitabine, stereotactic body radiotherapy or MR-guided ablative radiotherapy after induction chemotherapy for disease that has not spread; LAP07 shows better local control without longer survival. | NCCN Guidelines: Pancreatic Adenocarcinoma | 82 | |
| All comers | Conversion surgery | Exploration and resection, sometimes with arterial reconstruction, for the minority with stable or responding disease and a normalised CA 19-9 after induction. | NCCN Guidelines: Pancreatic Adenocarcinoma | - | |
| All comers | Ablation | Irreversible electroporation in selected centres after induction chemotherapy; no randomised evidence. | NCCN Guidelines: Pancreatic Adenocarcinoma | 32 |
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.