NEOADJUVANT
Neoadjuvant
- Prefer FOLFIRINOX if elig
- Need Grastofil primary GCSF proph (elig as curative intent)
- Desloratidine 2x / day on GCSF days to prevent bone pain
- Tumour marker q cycle (Ca 19-9) if elevated at baseline
- Baseline PET scan and Pancreas MRI, CT C/A/P
- Ensure MMR and mPREDICT FOCUS panel requested
Dr. Michael Humphreys
ADJUVANT
Adjuvant
Prefer FOLFINOX X 6 months if elig
- Need Grastofil primary GCSF proph
- Desloratidine 2x / day on GCSF days to prevent bone pain
Dr. Michael Humphreys
SURVEILLANCE
Surveillance
- Prefer surveillance with hepatobiliary surgery
- CT C/A/P q 6 monthly X 2 years
- H/P q 3-6 months X 2 years
- Ca 19-9 Q 6 monthly X 2 years
Dr. Michael Humphreys
STAGE IV
Stage IV
- Ensure MMR and mPREDICT FOCUS panel requested
- Baseline CT C/A/P and bone scan (omit if had a PET scan)
- Most patients will get gem/nab-paclitaxel upfront (FOLFIRINOX reasonable in very fit patients but limited 2nd line options so not necessary better and more toxic)
- Tumour marker q cycle (Ca 19-9) if elevated at baseline
- Repeat imaging for efficacy assessment prior to cycle 3
- Responders, repeat imaging q 3 months, may increase to q 4-6 monthly with durable responders – earlier if tumour marker rises
Dr. Michael Humphreys
In The Pipeline
- Watch this space
