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2016年ASCO指南:转移性胰腺癌

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发布日期:2016-05-31
英文标题:Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline
来源:J Clin Oncol, 2016, 34(23): 2784-2796
制定者:美国临床肿瘤协会(ASCO)

      To provide evidence-based recommendations to oncologists and others for the treatment of patients with metastatic pancreatic cancer.       American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts to conduct a systematic review of the literature from April 2004 to June 2015. Outcomes were overall survival, disease-free survival, progression-free survival, and adverse events.       Twenty-four randomized controlled trials met the systematic review criteria.       A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. Goals of care, patient preferences, treatment response, psychological status, support systems, and symptom burden should guide decisions for treatments. A palliative care referral should occur at first visit. FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin; favorable comorbidity profile) or gemcitabine plus nanoparticle albumin-bound (NAB) -paclitaxel (adequate comorbidity profile) should be offered to patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1 based on patient preference and support system available. Gemcitabine alone is recommended for patients with ECOG PS 2 or with a comorbidity profile that precludes other regimens; the addition of capecitabine or erlotinib may be offered. Patients with an ECOG PS ≥ 3 and poorly controlled comorbid conditions should be offered cancer-directed therapy only on a case-by-case basis; supportive care should be emphasized. For second-line therapy, gemcitabine plus NAB-paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX, an ECOG PS 0 to 1, and a favorable comorbidity profile; fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan should be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, ECOG PS 0 to 1, and favorable comorbidity profile, and gemcitabine or fluorouracil should be offered to patients with either an ECOG PS 2 or a comorbidity profile that precludes other regimens. Additional information is available at www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki.

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  • 1 病毒性肝炎
    • 1.1 乙型肝炎
    • 1.2 丙型肝炎
    • 1.3 甲型肝炎
    • 1.4 戊型肝炎
    • 1.5 其他肝炎
  • 2 肝硬化及并发症
  • 3 酒精性肝病
  • 4 非酒精性脂肪性肝病
  • 5 肝衰竭/肝性脑病/人工肝
  • 6 肝肿瘤
  • 7 自身免疫性肝病
  • 8 药物性肝病
  • 9 肝移植
  • 10 其他肝病
    • 10.1 遗传及代谢性肝病
    • 10.2 胆汁淤积性肝病
    • 10.3 肝脏血管病
  • 11 一般肝病/肝脏检查
  • 12 胆道疾病
  • 13 胰腺疾病
  • 14 全身疾病与肝病/内镜
  • 15 肝胆胰疾病相关评分系统汇总