Treatment protocols for pancreatic cancer

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with pancreatic cancer, both in the adjuvant setting and for advanced disease. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with pancreatic cancer. Additional regimens may be added over time, particularly as treatment for pancreatic cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with pancreatic cancer. Clinicians should refer to the individual disease-oriented topic reviews that discuss the use of these protocols in appropriate clinical situations:

●(See "Initial systemic chemotherapy for metastatic exocrine pancreatic cancer".)

●(See "Treatment for potentially resectable exocrine pancreatic cancer".)

●(See "Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

REGIMENS

Adjuvant setting

Adjuvant gemcitabine —  (table 1)

Adjuvant gemcitabine plus capecitabine —  (table 2)

Modified FOLFIRINOX —  (table 3)

Locally advanced/metastatic disease

Gemcitabine monotherapy —  (table 4)

Gemcitabine plus nanoparticle albumin-bound paclitaxel (nabpaclitaxel) —  (table 5)

Gemcitabine plus capecitabine —  (table 6)

Gemcitabine plus cisplatin —  (table 7)

FOLFIRINOX (fluorouracil plus leucovorin, irinotecan, and oxaliplatin) —  (table 8)

Modified FOLFIRINOX —  (table 3)

Modified FOLFOX6 (fluorouracil plus leucovorin and oxaliplatin) —  (table 9)

Liposomal irinotecan and 5-FU for metastatic pancreatic cancer —  (table 10)

Pembrolizumab monotherapy for microsatellite-unstable (mismatch repair-deficient) advanced cancer —  (table 11)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.