Current controversies and advances in the management of pancreatic adenocarcinoma

Table 7 Treatment protocols for locally advanced/metastatic pancreatic adenocarcinoma

Drug	Dose and route	Administration	Toxicity
Gemcitabine monotherapy (cycle length: 8 wk for first cycle, then 4 wk)[163-166]
Gemcitabine	1000 mg/m2 IV	Weekly (× 7 wk) followed by one week of rest in the first cycle, then weekly (× 3 wk) followed by one week of rest in all subsequent cycles	Myelotoxicity; Hepatoxicity; Pulmonary toxicity; Thrombotic microangiopathy
Gemcitabine plus nanoparticle albumin-bound paclitaxel (nabpaclitaxel) (cycle length: 4 wk)[167,168]
Nabpaclitaxel	125 mg/m2 IV	Given on days 1, 8, and 15	Myelotoxicity; Sepsis; Thrombotic microangiopathy; Peripheral neuropathy; Hepatotoxicity; Pulmonary toxicity
Gemcitabine	1000 mg/m2 IV	Given on days 1, 8, and 15
Gemcitabine plus capecitabine (cycle length: 21 d)[157,169]
Gemcitabine	1000 mg/m2 IV	Given on days 1 and 8	Myelotoxicity; Nonhematologic toxicity (including hepatoxicity); Pulmonary toxicity; Thrombotic microangiopathy
Capecitabine	650 mg/m2 per dose by mouth	Given on days 1 through 14
Gemcitabine plus cisplatin (cycle length: 21 d)[170]
Cisplatin	25 mg/m2 IV daily	Given on days 1 and 8	Myelotoxicity; Thrombotic microangiopathy; Pulmonary toxicity; Hepatotoxicity; Neurotoxicity; Nephrotoxicity
Gemcitabine	1000 mg/m2 IV daily	Given on days 1 and 8
FOLFIRINOX (fluorouracil plus leucovorin, irinotecan, and oxaliplatin) (cycle length: 14 d)[160,161]
Oxaliplatin	85 mg/m2 IV	Given on day 1	Myelotoxicity; Diarrhea; Mucositis or hand-foot syndrome; Pulmonary toxicity; Neurotoxicity; Cardiotoxicity
Leucovorin	400 mg/m2 IV	Given on day 1
Irinotecan	180 mg/m2 IV	Given on day 1
Fluorouracil	400 mg/m2 IV bolus	Given on day 1
FU	2400 mg/m2 IV	Given on day 1
Modified FOLFIRINOX (cycle length: 14 d)[158,159,161]
Oxaliplatin	85 mg/m2 IV	Given on day 1	Myelotoxicity; Diarrhea; Mucositis or hand-foot syndrome; Pulmonary toxicity; Neurotoxicity; Cardiotoxicity
Leucovorin	400 mg/m2 IV	Given on day 1
Irinotecan	150 mg/m2 IV	Given on day 1
Fluorouracil	2400 mg/m2 IV	Given on day 1
Modified FOLFOX6 (fluorouracil plus leucovorin and oxaliplatin) (cycle length: 14 d)[160,171,172]
Oxaliplatin	85 mg/m2 IV	Given on day 1	Myelotoxicity; Neurotoxicity; Diarrhea; Cardiopulmonary toxicity
Leucovorin	400 mg/m2 IV	Given on day 1
Fluorouracil	400 mg/m2 IV bolus	Given on day 1
FU	2400 mg/m2 IV	Given on day 1
Liposomal irinotecan and fluorouracil (cycle length: 14 d)[173]
Liposomal irinotecan	70 mg/m2 IV	Given on day 1	Myelotoxicity; Diarrhea; Neurotoxicity; Cardiotoxicity
Leucovorin	400 mg/m2 IV	Given on day 1
Fluorouracil	2400 mg/m2 IV	Given on day 1
Pembrolizumab monotherapy for microsatellite-unstable (mismatch repair-deficient) advanced cancer (cycle length: q3 weeks or q6 weeks)[174,175]
Pembrolizumab	200 mg IV	Given on day 1, every 3 wk	Pulmonary toxicity; Hepatotoxicity; Neurotoxicity; Dermatologic toxicityCardiotoxicity
OR
Pembrolizumab	400 mg IV	Given on day 1, every 6 wk