Locally Advanced Pancreatic Cancer: Treatment Approaches and Regimen Selection

Video content above is prompted by the following:

Expert oncologists discuss the complex treatment landscape for locally advanced pancreatic cancer, emphasizing the critical importance of excluding metastatic disease and assessing patient performance status before treatment selection. The discussion highlights that patients with locally advanced disease require systemic therapy for tumor downstaging since immediate surgical resection is not feasible. Current evidence shows limited definitive proof that radiation therapy improves overall survival in localized pancreatic cancer, though institutional practices vary regarding chemoradiation integration.

The treatment approach typically involves up-front systemic chemotherapy for several months followed by long-course radiation therapy in appropriate candidates. For younger patients with excellent performance status, triplet chemotherapy regimens are preferred, while treatment selection must consider the patient’s ability to tolerate prolonged therapy. The experts stress that patients with locally advanced pancreatic cancer often remain on treatment for extended periods compared with metastatic patients, making long-term toxicity considerations paramount in regimen selection.

Treatment decision-making in locally advanced pancreatic cancer requires careful balance between aggressive therapy and quality of life preservation. The limited trial data specific to locally advanced disease necessitate extrapolation from metastatic setting studies, emphasizing the importance of individualized treatment plans. Patient education about treatment goals, including the significance of stable disease as a positive outcome, helps establish appropriate expectations for this challenging clinical scenario.