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In England the funded pancreatic cancer drugs are the older chemotherapies: FOLFIRINOX, gemcitabine with capecitabine, gemcitabine alone, and nab-paclitaxel with gemcitabine when other combinations are unsuitable. Liposomal irinotecan after gemcitabine was turned down in 2017, and by September 2026 NICE had appraised none of NALIRIFOX, olaparib, daraxonrasib or zenocutuzumab for this cancer.
What NICE has decided. TA25 (8 May 2001) recommended gemcitabine and has been replaced by the guideline NG85. TA476 (6 September 2017, replacing TA360) recommends nab-paclitaxel with gemcitabine for untreated metastatic adenocarcinoma of the pancreas only if other combination chemotherapies are unsuitable and the person would otherwise have gemcitabine alone, with the patient access scheme discount. TA440 (26 April 2017) does not recommend pegylated liposomal irinotecan with fluorouracil and leucovorin after gemcitabine-based therapy. NG85 (7 February 2018, with prescribing notes updated to September 2025) offers FOLFIRINOX first line for performance status 0 to 1 and gemcitabine combinations or gemcitabine alone for those less fit (1.9.4 to 1.9.6), oxaliplatin-based or gemcitabine-based second-line chemotherapy (1.9.7 and 1.9.8), adjuvant gemcitabine plus capecitabine or gemcitabine alone (1.8.6 and 1.8.7), neoadjuvant therapy only within a trial (1.8.1 and 1.8.2), and systemic combination chemotherapy for locally advanced disease with capecitabine as the radiosensitiser when chemoradiotherapy is used (1.9.1 to 1.9.3); several of these uses are recorded as off-label. Tumour-agnostic drugs: larotrectinib for NTRK fusion-positive solid tumours is available through the Cancer Drugs Fund under a managed access agreement (TA630, 27 May 2020); entrectinib was in the Fund under TA644 (12 August 2020) until that appraisal was replaced by the terminated TA1118 (7 January 2026), because the company did not make a submission, and only people already on treatment continue. Pembrolizumab for mismatch repair deficient tumours (TA914, 20 September 2023) covers endometrial, gastric, small intestine, biliary and colorectal cancer and does not name pancreatic cancer.
What NICE has not appraised. Searches of nice.org.uk on 24 September 2026 for NALIRIFOX or liposomal irinotecan with oxaliplatin, olaparib in pancreatic cancer, daraxonrasib, zenocutuzumab, tumour treating fields and sotorasib returned no pancreatic appraisal (sotorasib has TA781 for lung cancer only), and the in-development list returned nothing for pancreatic cancer. The Scottish Medicines Consortium was not read for this page. The practical gap between the United States and England is therefore daraxonrasib (FDA approval 26 August 2026), NALIRIFOX (FDA 13 February 2024), olaparib maintenance for germline BRCA carriers (FDA 2019), zenocutuzumab for NRG1 fusions (FDA 4 December 2024) and Optune Pax (2026), none of which is routinely commissioned in England, while liposomal irinotecan after gemcitabine is licensed in the EU and UK but not recommended.
Showing the molecule this term concerns: Gemcitabine.
Shares NAPOLI-1, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Liposomal irinotecan, Gemcitabine + nab-paclitaxel.
Shares Liposomal irinotecan, Entrectinib, Larotrectinib, Gemcitabine + nab-paclitaxel.
Shares Entrectinib, Larotrectinib, Daraxonrasib, Sotorasib.
Shares ESPAC-4, Gemcitabine + nab-paclitaxel, Nab-paclitaxel, Gemcitabine.
Shares NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), FOLFIRINOX / mFOLFIRINOX, Nab-paclitaxel, Gemcitabine.
Shares NAPOLI-1, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Liposomal irinotecan, Daraxonrasib.
Shares CONKO-001, ESPAC-4, Gemcitabine, Pancreatic ductal adenocarcinoma.
Shares ESPAC-4, Capecitabine, Gemcitabine, Pancreatic ductal adenocarcinoma.