NCCN临床实践指南_胰腺癌(2019.V3)英文版

NCCN org NCCN Guidelines for Patients available at www nccn org patients Version 3 2019 07 02 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Pancreatic Adenocarcinoma Version 3 2019 July 2 2019 Continue Margaret A Tempero MD Chair UCSF Helen Diller Family Comprehensive Cancer Center Mokenge P Malafa MD Vice Chair Moffitt Cancer Center Mahmoud Al Hawary MD University of Michigan Rogel Cancer Center Horacio Asbun MD Mayo Clinic Cancer Center Stephen W Behrman MD The University of Tennessee Health Science Center Al B Benson III MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Ellen Binder MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Dana B Cardin MD Vanderbilt Ingram Cancer Center Charles Cha MD Yale Cancer Center Smilow Cancer Hospital E Gabriela Chiorean MD Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Vincent Chung MD City of Hope National Medical Center Brian Czito MD Duke Cancer Institute Marco Del Chiaro MD PhD University of Colorado Cancer Center Mary Dillhoff MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Efrat Dotan MD Fox Chase Cancer Center Cristina R Ferrone MD Massachusetts General Hospital Cancer Center George Fisher MD PhD Stanford Cancer Institute Christos Fountzilas MD Roswell Park Comprehensive Cancer Center Jeffrey Hardacre MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute William G Hawkins MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Andrew H Ko MD UCSF Helen Diller Family Comprehensive Cancer Center Noelle LoConte MD University of Wisconsin Carbone Cancer Center Andrew M Lowy MD UC San Diego Moores Cancer Center Cassadie Moravek Pancreatic Cancer Action Network Eric K Nakakura MD UCSF Helen Diller Family Comprehensive Cancer Center Amol K Narang MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Eileen M O Reilly MD Memorial Sloan Kettering Cancer Center Jorge Obando MD Duke Cancer Institute Sushanth Reddy MD O Neal Comprehensive Cancer Center at UAB Courtney Scaife MD Huntsman Cancer Institute at the University of Utah Sarah Thayer MD Fred 3 6 a002154 See Discussion and see NCCN Guidelines for Genetic Familial High Risk Assessment Breast and Ovarian Also on PANC 3 PANC 4 PANC 5 PANC 6 Footnote g modified Consider Somatic testing Tumor somatic gene profiling is recommended for patients with locally advanced metastatic disease who are candidates for anti cancer therapy to identify uncommon but actionable mutations Testing on tumor tissue is preferred however cell free DNA testing can be considered if tumor tissue testing is not feasible See Discussion Also on PANC 6 and PANC 8 PANC 5 Workup bullet added Germline testing if not previously done Also on PANC 6 and PANC 8 PANC 6 Workup bullet added Gene profiling of tumor tissue if not previously done also on PANC 8 PANC F 5 of 7 Second line therapy for locally advanced metastatic disease and therapy for recurrent disease Option added for patients with good performance status under useful in certain circumstances Larotrectinib if NTRK gene fusion positive Updates in Version 3 2019 of the NCCN Guidelines for Pancreatic Adenocarcinoma from Version 2 2019 include PANC 8 A footnote was added Consider olaparib as maintenance treatment for patients who have a deleterious germline BRCA1 2 mutation good PS metastatic disease and no disease progression during 16 weeks of first line platinum based chemotherapy Also added on PANC F 4 of 7 NCCN Guidelines Version 3 2019 Pancreatic Adenocarcinoma Version 3 2019 07 02 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 7 5 2019 1 22 04 AM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved UPDATES Updates in Version 1 2019 of the NCCN Guidelines for Pancreatic Adenocarcinoma from Version 2 2018 include General The following footnotes regarding stent management have been removed and recommendations are now outlined on PANC B ERCP endoscopic retrograde cholangiopancreatography PTC percutaneous transhepatic cholangiography Plastic stent or consider covered metal stent if clinically indicated Stent placement is not routinely recommended prior to planned surgery however stent may be considered for symptoms of cholangitis fever or if surgery is being delayed for any reason Stent should only be placed if tissue diagnosis is confirmed