Initial Treatment for Metastatic Pancreatic Cancer

Authored by Mike J. Pishvaian, published on 2026-03-05 05:19:12.0

Initial treatment for metastatic pancreatic cancer based on performance status and genetic testing.

  1. Treatment based on performance status (and/or patient preference)
    • PS 0-1 (some PS 2 with discretion)
      • FOLFIRINOX No 5FU Bolus Reduced Irinotecan (physician discretion) Or NALIRIFOX
        • Maintenance capecitabine until progression
    • PS 1-2 (PS 3 with discretion OR patient preference)
      • Gemcitabine + Nab-paclitaxel Days 1 and 15 only preferred until progression
  2. Treatment based on genetic testing (See testing algorithm)
    • Pathogenic BRCA1/2/PALB2-mutated
      • Gemcitabine +Cisplatin Days 1 and 15 only preferred
        • Maintenance olaparib until progression
    • KRAS-mutated*
      • KRAS Inhibitor *Only in trials
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