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NICE guideline 9: Managing pancreatic cancer that can’t be removed with surgery

Pancreatic cancer that has spread to nearby organs or blood vessels (locally advanced cancer)

9.1 If you have locally advanced pancreatic cancer, you should be offered a combination of chemotherapy drugs, if you are well enough to cope with the possible side effects.

9.2 If you have locally advanced pancreatic cancer and aren’t well enough for combination chemotherapy, your doctor should consider gemcitabine chemotherapy.

9.3 If you are having chemotherapy with radiotherapy (chemoradiotherapy), you should be offered the chemotherapy drug capecitabine.

Read more about chemotherapy and chemoradiotherapy.

Pancreatic cancer that has spread to other parts of the body (advanced or metastatic cancer)

First-line treatment

The first chemotherapy drugs you have are called first-line chemotherapy

9.4 If you have advanced pancreatic cancer, you should be offered FOLFIRINOX chemotherapy if you are very fit and well enough to cope with the possible side effects. 

9.5 If you have advanced pancreatic cancer and are not well enough for FOLFIRINOX, your doctor should consider gemcitabine together with other drugs such as capecitabine.

NICE have also previously recommended that nab-paclitaxel (Abraxane®) together with gemcitabine is an option for people with advanced pancreatic cancer who can't have FOLFIRINOX or GemCap (gemcitabine with capecitabine).

9.6 If you have advanced pancreatic cancer and are not well enough for a combination of chemotherapy drugs, you should be offered gemcitabine alone.

Read more about chemotherapy.

Second-line treatment

When one chemotherapy treatment stops working or if it hasn’t worked, different chemotherapy drugs may be used to try to control the cancer for longer. This is called second-line chemotherapy

9.7 If you need second-line chemotherapy and haven’t already had chemotherapy that included oxaliplatin, your doctor should consider chemotherapy that includes oxaliplatin.  

9.8 If you need further chemotherapy after FOLFIRINOX, your doctor should consider chemotherapy that includes gemcitabine.

Read more about chemotherapy.

Preventing a blood clot in a vein

People with pancreatic cancer may be at higher risk of a blood clot in a vein.

Doctors should consider giving people with pancreatic cancer who are having chemotherapy a drug called low-molecular-weight heparin (LMWH) to try to prevent a blood clot forming in a vein.

Read other sections of the NICE guidelines for pancreatic cancer: 

Information Standard

Published: August 2018

Review date: August 2020