Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

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Pancreatic Adenocarcinoma — Treatment by Stage

First-line Second-line SECOND-LINE Pancreatic adenocarcinoma Resectable / borderline Metastatic · good PS Metastatic · poor PS Biomarker-directed Second-line (post-gem) Adjuvant Surgery → adjuvant mFOLFIRINOX PRODIGE-24 ↗ Alternative Gemcitabine + capecitabine ESPAC-4 ↗ Triplet FOLFIRINOX PRODIGE 4/ACCORD 11 ↗ Doublet Gemcitabine + nab-paclitaxel MPACT ↗ Triplet NALIRIFOX NAPOLI-3 ↗ Gentler Gemcitabine ± nab-paclitaxel MPACT ↗ Supportive Best supportive care symptom-directed gBRCA Platinum → maintenance olaparib POLO ↗ MSI-H Pembrolizumab dMMR / TMB-high ↗ Cytotoxic Liposomal irinotecan + 5-FU/LV NAPOLI-1 ↗ Cytotoxic FOLFOX / FOLFIRI if not used