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Cancers & treatments·Sequencing

Resectable pancreatic ductal adenocarcinoma: lines of therapy

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6 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersGermline
Screening, prevention and diagnosis1·
Early / localised2·
Other settings21

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
All comersStagingPancreas-protocol CT, chest CT and CA 19-9; endoscopic ultrasound with biopsy when tissue is needed before treatment; biliary stenting only for cholangitis, deep jaundice or delayed surgery.
CT (computed tomography)CA 19-9Endoscopic ultrasound and EBUS systemsBiliary stenting and drainageResectable, borderline resectable and unresectable
66

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersAdjuvant chemotherapySix months of modified FOLFIRINOX for fit patients (PRODIGE 24); gemcitabine plus capecitabine (ESPAC-4) or gemcitabine alone (CONKO-001) for those who cannot tolerate it, started within twelve weeks of surgery.
FOLFIRINOX / mFOLFIRINOXPRODIGE 24 / CCTG PA6GemcitabineCapecitabineNeoadjuvant / adjuvant / perioperative
90
All comersNeoadjuvant chemotherapyConsidered for tumours with high-risk features (large size, very high CA 19-9, suspicious nodes) and increasingly offered in trials for all resectable disease; PREOPANC and NORPACT-1 are the evidence for and against.
FOLFIRINOX / mFOLFIRINOXPREOPANC-1 / PREOPANC-2Gemcitabine + nab-paclitaxelNeoadjuvant / adjuvant / perioperative
83

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersSurgeryPancreatoduodenectomy for head tumours, distal pancreatectomy with splenectomy for body and tail tumours, with regional lymphadenectomy; open, laparoscopic or robotic in high-volume centres.
Whipple procedure (pancreaticoduodenectomy)Robotic & minimally invasive surgeryLymphadenectomy (lymph node dissection)Resection margins (R0 / R1 / R2)
40
All comersFollow-upCA 19-9 and CT every three to six months for two years then less often; recurrence is treated as metastatic or locally advanced disease.
CA 19-9CT (computed tomography)
66
GermlineGermline testingOffered to every patient at diagnosis; carriers of BRCA, PALB2 or ATM variants receive platinum-based chemotherapy and their relatives are offered testing and surveillance.
Germline (hereditary) testingGermline BRCA mutation (gBRCA)High-risk pancreatic surveillance (CAPS / PRECEDE)
94

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.