International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer

Abstract

Background

Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies.

Methods

A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent.

Results

Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines.

Conclusion

The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.

Introduction

In 2014 it was estimated that there were 337,872 newly diagnosed pancreatic cancers world-wide, making this the 12th most common cancer worldwide [1]. Unfortunately, 330,391 of these patients died of the disease in the same year [1]. In many developed and developing countries, the number of patients with pancreatic cancer is increasing year by year. Tremendous efforts have been made to improve survival; e.g., investigations on mechanisms of carcinogenesis and tumor progression, implementation of various modalities for early detection and staging, development of new therapeutic agents, improvement of surgical techniques. Despite these efforts, however, the high mortality rate remains essentially the same. Nevertheless, there is hope because of emerging evidence for new therapeutic options, which have shown some survival advantage for patients with pancreatic cancer [2]. In order to provide patients with evidence-based practice, a number of guidelines focusing on the active treatment of pancreatic cancer have been created by many scientific societies and medical organizations all over the world. A systemic comparison of the recommendations from the existing guidelines has never been attempted, and yet this would be helpful for acceptance into clinical practice and to define future research.

During the combined 46th European Pancreatic Club (EPC) and International Association of Pancreatology (IAP) Meeting, held in Southampton, UK, in June 2014, the IAP/EPC study group on the clinical management of pancreatic cancer was assembled with the aim to critically review the existing guidelines.