NCCN Announces Updates To Pancreatic Adenocarcinoma Guidelines

Main Category: Pancreatic Cancer
Also Included In: Cancer / Oncology;  MRI / PET / Ultrasound;  Conferences
Article Date: 14 Mar 2009 - 1:00 PDT

email to a friend   printer friendly   view / write opinions

The National Comprehensive Cancer Network (NCCN) presented important updates to the NCCN Clinical Practice Guidelines in Oncology(TM) for Pancreatic Adenocarcinoma at the NCCN 14th Annual Conference. Margaret A. Tempero, MD, of UCSF Helen Diller Family Comprehensive Cancer Center, presented the updated NCCN Guidelines that promoted more individualized management, clarified required diagnostic imaging, and placed increased emphasis on systemic therapy in all disease stages.

The 2009 version of the NCCN Guidelines clarify the recommendations for diagnostic imaging in patients with pancreatic cancer. The panel recommends that imaging should include a pancreatic computed tomography (CT) scan performed according to a defined pancreas protocol, such as triphasic cross-sectional imaging and thin slices, and that PET scan may be considered useful if CT results are equivocal. The panel emphasized that decisions about disease management and resectability should involve close multidisciplinary cooperation.

Also new to the 2009 NCCN Guidelines is the recommendation to consider laparoscopy prior to resection in high-risk (e.g. those with disabling symptoms or equivocal CT findings) patients considered to have resectable disease at presentation. Laparoscopy is also recommended after neoadjuvant therapy in patients with borderline resectable disease, prior to laparotomy.

Another important addition to the NCCN Guidelines is a revised set of criteria based on a consensus of the panel members which defines borderline resectable disease.

Dr. Tempero also provided additional clarification regarding the importance of upfront systemic therapy prior to administration of chemoradiation therapy stating that, "Radiation is important for a subset of patients with local disease only, but systemic chemotherapy should be given first."

Upfront systemic therapy provides for disease control and allows selection of those patients most likely to benefit from subsequent chemoradiation.

Dr. Tempero also recommended fluorinated pyrimidine-based therapy with oxaliplatin (Eloxatin(R), sanofi-aventis) as a second-line option for patients with advanced disease and good performance status based on results of clinical trial that showed a significant survival benefit for patients receiving the combination of therapies.

Dr. Tempero summarized the recommendations for patients with metastatic disease by saying, "Single agent gemcitabine (Gemzar(R), Eli Lilly and Company) or selected gemcitabine combinations followed by a fluorinated pyrimidine plus oxaliplatin is the standard of care."

Of all the gastrointestinal malignancies, pancreatic adenocarcinoma is the second most common cause of death from cancer. The diagnosis of pancreatic cancer is rarely made at an early stage, which is one of the main reasons for failing to achieve a cure in most patients.

Dr. Tempero illustrated this point further during the presentation stating that, "80 percent of patients with pancreatic cancer relapse systematically even with adjuvant therapy" and that "clinicians must keep this in mind as we treat our patients."

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

The NCCN Member Institutions are: City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University, Columbus, OH; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.

For more information on NCCN, please visit http://www.nccn.org.

National Comprehensive Cancer Network
http://www.nccn.org