Indian council of medical research consensus document for the management of pancreatic cancer

Executive Summary

This consensus document may be used as framework for more focused and planned research programs to carry forward the process. The aim of the Indian Council of Medical Research (ICMR) Guidelines is to assist oncologists in making major clinical decisions encountered while managing their patients and while realizing the fact that some patients may require treatment strategies other than those suggested in these guidelines.

• Histological confirmation is mandatory before the commencement of definitive treatment

• All patients should be staged according to the tumor, node, and metastasis staging system, and risk should be assessed at diagnosis. A baseline contrast-enhanced computed tomography (CT) scan of the chest, abdomen, and pelvis should be considered

• Patients should receive multidisciplinary care under the care of a surgical, medical, and radiation oncologist

• The indication for endobiliary stenting in patients with obstructive jaundice includes symptoms of cholangitis and/or sepsis, resultant coagulopathy and/or renal insufficiency, or if significant delays in surgery are anticipated

• The patient's malignancy should be classified as resectable, borderline resectable, or locally advanced on the basis of radiologic criteria at diagnosis and treatment plan discussed accordingly

• Resectable pancreatic cancer – Primary surgery remains the standard of care. Neoadjuvant therapy (NAT) (chemotherapy ± radiotherapy) should be considered in locally advanced and borderline resectable tumors to downstage the disease followed by reassessment for surgery in those with stable or partial regression radiological criteria. This may be followed by adjuvant chemotherapy

• Patients with metastatic disease that has spread beyond regional lymph nodes should be assessed for chemotherapy versus best supportive care on an individual basis

• Preferred first-line regimens for chemotherapy include Gemcitabine nab-paclitaxel and FOLFIRINOX

• Patients should be offered regular surveillance after completion of curative resection or treatment of advanced disease

• Encourage participation in institutional and ethical review board-approved, registered clinical trials

• Refer for early palliative care, if indicated.

Publication History

Article published online:
08 June 2021

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