From the Guidelines
The primary treatment for adenocarcinoma of the pancreatic head is surgical resection, usually through the Whipple procedure (pancreaticoduodenectomy), as it is the only potentially curative technique for managing pancreatic cancer 1. For resectable tumors, the primary treatment is surgical resection, usually through the Whipple procedure (pancreaticoduodenectomy). This is followed by adjuvant chemotherapy, typically with either FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) for 6 months or gemcitabine plus capecitabine for 6 months. Some key points to consider in the treatment of adenocarcinoma of the pancreatic head include:
- The goal of surgery is to achieve an R0 resection, which is the removal of all cancerous tissue with negative margins 1.
- Neoadjuvant therapy is sometimes used in patients with borderline resectable or locally advanced tumors to attempt to shrink the tumor before surgery, with FOLFIRINOX being a preferred regimen for 2-4 months, followed by chemoradiation if the tumor remains unresectable 1.
- In cases of unresectable or metastatic disease, systemic chemotherapy is the mainstay of treatment, with the two standard first-line regimens being FOLFIRINOX or gemcitabine plus nab-paclitaxel 1.
- Throughout treatment, it's crucial to manage symptoms and provide supportive care, including pain management, nutritional support, and addressing pancreatic exocrine insufficiency with pancreatic enzyme replacement therapy 1.
- A multidisciplinary approach is essential due to the complex nature of pancreatic cancer and its treatment, involving oncologists, surgeons, radiologists, and palliative care specialists.
From the FDA Drug Label
- 4 Pancreatic Cancer Gemcitabine Injection is indicated as first-line treatment for patients with locally advanced (nonresectable Stage II or Stage III) or metastatic (Stage IV) adenocarcinoma of the pancreas. Gemcitabine Injection is indicated for patients previously treated with fluorouracil.
The treatment for adenocarcinoma of the pancreatic head is Gemcitabine Injection as a first-line treatment for patients with locally advanced or metastatic disease, and also for patients previously treated with fluorouracil 2.
- Key points:
- Gemcitabine Injection is indicated for locally advanced or metastatic adenocarcinoma of the pancreas.
- Gemcitabine Injection is also indicated for patients previously treated with fluorouracil.
From the Research
Treatment Options for Adenocarcinoma of the Pancreatic Head
The treatment for adenocarcinoma of the pancreatic head involves a multidisciplinary approach, including:
- Surgical resection, which is considered the only potentially curative treatment 3, 4, 5
- Adjuvant systemic chemotherapy and radiation, which can be used preoperatively and postoperatively to improve long-term survival 3, 6, 4
- Neoadjuvant therapy, which can provide benefits of eradication of micrometastasis and improved delivery of intended treatment 6, 7
Surgical Treatment
The standard surgical treatment for resectable pancreatic carcinoma is considered the classic pancreatoduodenectomy (PD) with the Kausch-Whipple procedure, or the pylorus-preserving PD with the Traverso-Longmire method 5. Other surgical techniques, such as radical proximal-distal modular pancreatosplenectomy (RAMPS) and "the TRIANGLE operation", have also been developed to improve outcomes 5.
Chemotherapy and Radiation
Chemotherapy regimens, such as fluorouracil, leucovorin, irinotecan, and oxaliplatin, and gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel, have been shown to improve overall survival 6, 4. Radiation therapy can also be used in combination with chemotherapy to improve outcomes 6, 4.
Multidisciplinary Approach
A multidisciplinary approach, involving a team of specialists, including surgeons, medical oncologists, radiation oncologists, and other healthcare professionals, is essential for the diagnosis, staging, treatment, follow-up, and study of patients with pancreatic malignancy 3, 7.