Treatment of Metastatic Pancreatic Cancer with ECOG Performance Status 0–1 and Serum Bilirubin Below 1.5× ULN

Clinical Scenario

This protocol addresses patients with metastatic pancreatic cancer who remain functionally well, with an ECOG performance status of 0 or 1, and whose serum bilirubin is below 1.5 times the upper limit of normal. This combination of functional status and liver function determines eligibility for intensive first-line systemic therapy.

First-Line Treatment Approach

For patients meeting these criteria, first-line systemic combination chemotherapy is the recommended approach. Specific regimen selection is guided by patient factors and institutional practice.

The full regimen options, selection criteria, and sequencing are detailed in the complete protocol below.

Treatment Monitoring Goals

Response to treatment is typically evaluated every 8–12 weeks, drawing on clinical status, CA 19-9 trajectory, and imaging findings together.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2023.08.009

In patients with ECOG PS 0-1 and bilirubin level <1.5 times the ULN, two regimens should be considered: FOLFIRINOX [I, A; ESMO-MCBS v1.1 score: 5] or GN [I, A; ESMO-MCBS v1.1 score: 3].

The efficacy of treatment should be typically evaluated every 8-12 weeks and should be based on clinical status, CA 19-9 trajectory and imaging [III, A].

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