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Pancreatic Cancer — SCE Medical Oncology MCQ

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HardGI CancersPancreatic CancerSCE Medical Oncology

A 66-year-old with metastatic pancreatic adenocarcinoma has ECOG performance status 1, bilirubin below 1.5 times the upper limit of normal and no major comorbidity. Which first-line regimen should be offered under NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — FOLFIRINOX as combination treatment for a fit ECOG 1 patient

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

A is correct. NICE NG85 says to offer FOLFIRINOX for metastatic pancreatic cancer in people with ECOG 0 or 1 who can tolerate it. Adequate bilirubin and fitness support irinotecan-containing treatment. FOLFOX omits a defining active component, gemcitabine alone is generally reserved for people less able to tolerate combination treatment, and gemcitabine-nab-paclitaxel is a NICE option when other combination chemotherapy is unsuitable and gemcitabine would otherwise be used. Erlotinib is not routine unselected UK first-line therapy. Modified local dosing may be used, but the evidence-based regimen remains FOLFIRINOX.

Reference: NICE NG85 pancreatic cancer recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations