title: Consensus on the treatment of pancreatic cancer in Spain.
abstract: Pancreatic cancer (PC) represents one of the greatest oncological challenges of our century, due to its high mortality and incidence. A group of Spanish experts in PC treatment reviewed data available on different therapeutic combinations and established consensus on what would be the best strategy in PC management, depending on the stage of the disease. Surgery with complete resection may produce 5-year survival rates of 18-24%, but definitive control is still precarious. In the absence of consensus, the best evidence suggests that adjuvant chemotherapy with gemcitabine for 6 months using the CONKO-001 regime is the treatment of choice after resection of PC for patients with acceptable functional status. This group recommends chemoradiotherapy (CT-RT) in patients with factors for poor loco-regional prognosis. However, chemotherapy is an option for the treatment of locally advanced PC in patients with good general status and in the absence of metastatic disease the recommended treatment is CT-RT followed by gemcitabine-based chemotherapy. A period of chemotherapy followed by consolidation CT-RT may be appropriate, as it allows selection of patients with locally advanced disease who may benefit most from combined treatment. Erlotinib combined with gemcitabine shows significant survival improvement in PC and must be considered an option in the first-line treatment of advanced and metastatic PC. The gemcitabine-erlotinib combination is proposed as the standard treatment for metastatic PC in patients with PS=/>2. In patients with PS<2, gemcitabine-erlotinib is recommended as the first-line treatment option, supported by a maximum degree of evidence, without ruling out other options, such as gemcitabine-oxaliplatin, gemcitabine-capecitabine or gemcitabine alone.
authors.affiliation: Hospital de Madrid Norte Sanchinarro, Madrid, Spain. mhidalg1jhmi.edu
authors.forename: M
authors.initials: M
authors.lastname: Hidalgo
authors.forename: A
authors.initials: A
authors.lastname: Abad
authors.forename: E
authors.initials: E
authors.lastname: Aranda
authors.forename: L
authors.initials: L
authors.lastname: Díez
authors.forename: J
authors.initials: J
authors.lastname: Feliu
authors.forename: C
authors.initials: C
authors.lastname: Gómez
authors.forename: A
authors.initials: A
authors.lastname: Irigoyen
authors.forename: R
authors.initials: R
authors.lastname: López
authors.forename: F
authors.initials: F
authors.lastname: Rivera
authors.forename: C
authors.initials: C
authors.lastname: Rubio
authors.forename: J
authors.initials: J
authors.lastname: Sastre
authors.forename: J
authors.initials: J
authors.lastname: Tabernero
authors.forename: E
authors.initials: E
authors.lastname: Díaz-Rubio
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy; D013030:Spain