Pancreatic acinar cell carcinoma: lines of therapy

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4 standard-of-care settings across 4 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Screening, prevention and diagnosis	1
Early / localised	1
Advanced, first line	1
Other settings	1

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Diagnosis	Biopsy with acinar markers; CT staging; germline testing and comprehensive tumour sequencing with fusion detection for every patient.	Endoscopic ultrasound and EBUS systemsCT (computed tomography)Germline (hereditary) testingComprehensive genomic profiling	NCCN Guidelines: Pancreatic Adenocarcinoma	94

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resectable	Pancreatoduodenectomy or distal pancreatectomy even for large tumours, with adjuvant chemotherapy by extrapolation from ductal adenocarcinoma, usually a fluoropyrimidine and oxaliplatin regimen.	Whipple procedure (pancreaticoduodenectomy)FOLFOX (5-FU, leucovorin, oxaliplatin)FOLFIRINOX / mFOLFIRINOXNeoadjuvant / adjuvant / perioperative	NCCN Guidelines: Pancreatic Adenocarcinoma	82

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Advanced	FOLFOX or FOLFIRINOX preferred over gemcitabine-based regimens on retrospective evidence; resection of the primary and limited metastases considered after response.	FOLFOX (5-FU, leucovorin, oxaliplatin)FOLFIRINOX / mFOLFIRINOXOxaliplatinFluorouracil (5-FU)Oligometastatic disease	NCCN Guidelines: Pancreatic Adenocarcinoma	85

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Molecularly selected	MEK inhibition for BRAF fusions on case-series evidence; platinum and PARP inhibitors for homologous recombination defects; pembrolizumab for mismatch repair deficiency.	Dabrafenib + trametinibOlaparibPembrolizumabGene fusionHomologous recombination deficiency (HRD)	NCCN Guidelines: Pancreatic Adenocarcinoma	98

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.