Протокова аденокарцинома підшлункової залози
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DIS-PDAC |
|---|---|
| Тип | Хвороба |
| Синоніми | Pancreatic cancer (ductal)Pancreatic ductal adenocarcinomaПротокова аденокарцинома підшлункової залози |
| Статус | переглянуто 2026-04-26 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-ESMO-PANCREATIC-2024 SRC-NCCN-PANCREATIC-2025 |
Інформаційна підтримка. Усі рекомендації має перевірити кваліфікований онколог. Технічні перевірки не є клінічною валідацією чи схваленням лікування.
| icd_o_3_morphology | 8500/3 |
|---|---|
| icd_o_3_topography | ["C25"] |
| icd_10 | C25 |
| who_classification | WHO Digestive System Tumours 5th ed: Ductal adenocarcinoma of pancreas |
Нотатки
Скафолд для Phase GI-1: один червоний прапор (біліарна обструкція / холангіт — найчастіша гостра декомпенсація), одне показання (FOLFIRINOX у першій лінії метастатичної терапії як найбільш застосовний скафолдний варіант), один алгоритм. Стратифікація для резектабельної / пограничної / місцево-поширеної форми, а також ад'ювантний mFOLFIRINOX з підтримкою олапарибом (olaparib) при BRCA — очікують ратифікації пропозиції та клінічного авторства. Ключові біомаркери: герміногенні BRCA1/2 + PALB2 (POLO — олапариб у підтримці), MSI/dMMR (~1% — рідкісний, але пацієнти підлягають пембролізумабу (pembrolizumab)), KRAS G12C (рідкісний — ~1-2% PDAC, ємний клас соторасибу (sotorasib)).
Де використовується
Algorithms
ALGO-AMSTERDAM-II-LYNCH- ALGO-AMSTERDAM-II-LYNCHALGO-BOADICEA-V6-BREAST-OVARIAN- ALGO-BOADICEA-V6-BREAST-OVARIANALGO-BRCAPRO- ALGO-BRCAPROALGO-HEREDITARY-MELANOMA-SURVEILLANCE- ALGO-HEREDITARY-MELANOMA-SURVEILLANCEALGO-MANCHESTER-BRCA- ALGO-MANCHESTER-BRCAALGO-NCCN-PANCREATIC-CAPS-SURVEILLANCE- ALGO-NCCN-PANCREATIC-CAPS-SURVEILLANCEALGO-PDAC-LAPC- ALGO-PDAC-LAPCALGO-PDAC-METASTATIC-1L- ALGO-PDAC-METASTATIC-1LALGO-PDAC-METASTATIC-2L- ALGO-PDAC-METASTATIC-2LALGO-PDAC-RESECTABLE-PERIOP- ALGO-PDAC-RESECTABLE-PERIOPALGO-PEUTZ-JEGHERS-CARRIER-SURVEILLANCE- ALGO-PEUTZ-JEGHERS-CARRIER-SURVEILLANCEALGO-PREMM5-LYNCH- ALGO-PREMM5-LYNCH
Procedures
SUR-WHIPPLE- Pancreaticoduodenectomy (Whipple)
Questionnaires
QUEST-PDAC-1L-STUB- Pancreatic ductal adenocarcinoma — first line
Sources
SRC-CANTO-CAPS-2018- International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management...SRC-CAPS-CONSORTIUM-PANCREATIC-2020- Management of patients with increased risk for familial pancreatic cancer — updated recom...SRC-ESMO-PANCREATIC-2024- ESMO Pancreatic CancerSRC-ESPAC-5F-GHANEH-2023- Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, F...SRC-NAPOLI-3-WAINBERG-2024- NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastat...SRC-NCCN-PANCREATIC-2025- NCCN Pancreatic AdenocarcinomaSRC-NORPACT-1-LABORI-2024- Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORP...SRC-PRODIGE-24-CONROY-2018- FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
Клінічна застосовність
BMA-ATM-GERMLINE-PDAC- ATM germline pathogenic confers ~5-10× pancreatic-cancer risk; PARPi activity in ATM-muta...BMA-ATM-SOMATIC-PDAC- Somatic ATM loss-of-function in PDAC: limited evidence; platinum sensitivity may be enhan...BMA-BRAF-V600E-PDAC- BRAF V600E in PDAC (~1-3%, often in KRAS-WT subset). Tissue- agnostic dabrafenib + tramet...BMA-BRCA1-GERMLINE-PDAC- BRCA1 germline pathogenic in metastatic PDAC after ≥16 weeks of platinum without progress...BMA-BRCA1-SOMATIC-PDAC- Somatic BRCA1 loss-of-function in metastatic PDAC: POLO trial restricted to germline; som...BMA-BRCA2-GERMLINE-PDAC- BRCA2 germline pathogenic in metastatic PDAC: olaparib maintenance after ≥16 weeks platin...BMA-BRCA2-SOMATIC-PDAC- Somatic BRCA2 loss-of-function in metastatic PDAC: POLO germline-only; somatic series sug...BMA-CA-19-9-PANCREATIC-CAPS-SURVEILLANCE- CA 19-9 is the principal serum biomarker for pancreatic ductal adenocarcinoma (PDAC) — us...BMA-GNAS-IPMN- GNAS R201 mutations are detected in ~40–70% of IPMNs (predominantly main-duct and mixed-t...BMA-HRD-STATUS-PDAC- Germline BRCA1/2 mutation in metastatic PDAC (~5-7%): olaparib monotherapy maintenance af...BMA-KRAS-A146T-PDAC- KRAS A146T in PDAC — rare; no approved targeted therapy.BMA-KRAS-G12C-PDAC- KRAS G12C is rare in PDAC (~1-2%, vs ~30% G12D and ~25% G12V). Sotorasib (CodeBreaK 100 P...BMA-KRAS-G12D-PDAC- KRAS G12D is the most common PDAC driver (~35-40%). MRTX1133 (Mirati/Bristol) and RMC-980...BMA-KRAS-G12V-PDAC- KRAS G12V in PDAC — second-most common driver. No approved drug 2026; pan-KRAS inhibitors...BMA-KRAS-Q61-PDAC- KRAS Q61 in PDAC (rare vs G12) — no approved drug; chemo + clinical trial.BMA-NRG1-FUSION-PDAC- NRG1 fusions occur in ~0.5% of pancreatic ductal adenocarcinoma (PDAC) — a rare but actio...BMA-PALB2-GERMLINE-PDAC- PALB2 germline pathogenic in metastatic PDAC: behaves BRCA-like; case series support plat...BMA-PALB2-SOMATIC-PDAC- Somatic PALB2 in PDAC: rare; off-label PARPi after platinum response per NCCN HRR-mutated...BMA-TP53-MUT-PDAC- TP53 mutation in PDAC — common, adverse prognostic; not directly targeted. Per usual algo...
Показання
IND-CDKN2A-PDAC-CARRIER-OBSERVATION- IND-CDKN2A-PDAC-CARRIER-OBSERVATIONIND-CDKN2A-PDAC-CARRIER-SURVEILLANCE- IND-CDKN2A-PDAC-CARRIER-SURVEILLANCEIND-CHRONIC-PANCREATITIS-PDAC-PREVENTION-OBSERVATION- IND-CHRONIC-PANCREATITIS-PDAC-PREVENTION-OBSERVATIONIND-CHRONIC-PANCREATITIS-PDAC-PREVENTION-SURVEILLANCE- IND-CHRONIC-PANCREATITIS-PDAC-PREVENTION-SURVEILLANCEIND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-OBSERVATION- IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-OBSERVATIONIND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-SURVEILLANCE- IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-SURVEILLANCEIND-FAMMM-SUSPICION-PREVENTION-ENHANCED-SURVEILLANCE- IND-FAMMM-SUSPICION-PREVENTION-ENHANCED-SURVEILLANCEIND-FAMMM-SUSPICION-PREVENTION-GENETIC-COUNSELING- IND-FAMMM-SUSPICION-PREVENTION-GENETIC-COUNSELINGIND-FPC-PANCREATIC-OBSERVATION- IND-FPC-PANCREATIC-OBSERVATIONIND-FPC-PANCREATIC-SURVEILLANCE- IND-FPC-PANCREATIC-SURVEILLANCEIND-PDAC-ADJUVANT-MFOLFIRINOX- IND-PDAC-ADJUVANT-MFOLFIRINOXIND-PDAC-BORDERLINE-RESECTABLE-NEOADJ-FOLFIRINOX- IND-PDAC-BORDERLINE-RESECTABLE-NEOADJ-FOLFIRINOXIND-PDAC-LAPC-CHEMORADIATION- IND-PDAC-LAPC-CHEMORADIATIONIND-PDAC-MAINTENANCE-OLAPARIB-BRCA- IND-PDAC-MAINTENANCE-OLAPARIB-BRCAIND-PDAC-METASTATIC-1L-FOLFIRINOX- IND-PDAC-METASTATIC-1L-FOLFIRINOXIND-PDAC-METASTATIC-1L-GEM-NAB-PAC- IND-PDAC-METASTATIC-1L-GEM-NAB-PACIND-PDAC-METASTATIC-1L-NALIRIFOX- IND-PDAC-METASTATIC-1L-NALIRIFOXIND-PDAC-METASTATIC-2L-NAL-IRI- IND-PDAC-METASTATIC-2L-NAL-IRI
Схема лікування
REG-NAL-IRI-5FU-LV-PDAC- Nal-IRI + 5-FU/LV (PDAC, 2L nanoliposomal irinotecan)
Тривожна ознака
RF-ATM-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic monoallelic variant in ATM (heterozygou...RF-ATM-FAMILY-HISTORY-SUSPICION- Family pedigree pattern suggestive of germline ATM heterozygous carrier state in an asymp...RF-BRCA-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in BRCA1 or BRCA2 — the canonic...RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION- Family pedigree meeting criteria suggestive of Hereditary Breast and Ovarian Cancer (HBOC...RF-CASCADE-BRCA-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CASCADE-FAP-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CASCADE-LYNCH-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CDKN2A-SPECIFIC-PDAC-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in CDKN2A (p16/INK4a) — gene-sp...RF-CHRONIC-PANCREATITIS-PDAC-PREVENTION- Chronic pancreatitis — alcoholic etiology (≥10y heavy use), hereditary (PRSS1 or SPINK1 p...RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION- Established type-2 diabetes mellitus (HbA1c ≥6.5% on two occasions, or established T2DM d...RF-FAMILIAL-PANCREATIC-CANCER-SYNDROME- Familial Pancreatic Cancer (FPC) — operational definition: an individual with ≥2 first-de...RF-FAMMM-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in the CDKN2A (p16-INK4a) gene...RF-FAMMM-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of FAMMM (Familial Atypical Multiple Mole Melanoma) syndrome /...RF-FAP-CONFIRMED-CARRIER- Patient has a confirmed germline APC pathogenic variant. Mandates structured colorectal +...RF-FAP-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of Familial Adenomatous Polyposis (FAP) or the attenuated FAP...RF-JPS-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in SMAD4 or BMPR1A — Juvenile P...RF-LIFESTYLE-SMOKELESS-TOBACCO-PREVENTION- Habitual use of smokeless tobacco products — chewing tobacco, snus (oral nicotine pouch w...RF-LIFESTYLE-SUGARY-BEVERAGES-PREVENTION- High habitual intake of sugar-sweetened beverages (SSBs) — sodas, fruit drinks, sports dr...RF-LIFESTYLE-TOBACCO-CANCER-PREVENTION- Active tobacco smoking (current smoker OR cessation <15 years) OR smokeless tobacco use O...RF-LYNCH-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in a Lynch syndrome (MMR / EPCA...RF-LYNCH-FAMILY-HISTORY-SUSPICION- Family pedigree meeting criteria suggestive of hereditary nonpolyposis colorectal cancer...RF-PALB2-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic monoallelic variant in PALB2 (heterozyg...RF-PALB2-FAMILY-HISTORY-SUSPICION- Family pedigree pattern suggestive of germline PALB2 heterozygous carrier state in an asy...RF-PAN-ATM-CHEK2-CDK12-PARPI-CANDIDATE- Germline pathogenic variant in ATM, CHEK2, or CDK12 (composite HRR-pathway RF). Disease-s...RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE- Somatic (tumor-only) BRCA1 or BRCA2 pathogenic variant identified on tumor NGS — pan-tumo...RF-PAN-PALB2-PARPI-CANDIDATE- Germline PALB2 pathogenic variant — BRCA2's recruitment partner; biallelic LOF produces a...RF-PDAC-BILIARY-OBSTRUCTION-CHOLANGITIS- Obstructive jaundice / cholangitis in PDAC: total bilirubin ≥3 mg/dL with pancreatic-head...RF-PDAC-FIT-FOR-FOLFIRINOX- Fitness for FOLFIRINOX in metastatic PDAC per PRODIGE-4 / ACCORD-11 inclusion criteria (C...RF-PDAC-FRAILTY-AGE- Frailty profile precluding FOLFIRINOX in PDAC: ECOG ≥2, OR (age ≥75 + Charlson ≥3), OR co...RF-PDAC-HIGH-RISK-BIOLOGY- Actionable molecular biology in PDAC: germline BRCA1/2 (or PALB2 — HRD-equivalent → olapa...RF-PDAC-INFECTION-SCREENING- Infection-screening gate before PDAC FOLFIRINOX / gem-nab-pac: HBsAg+ / anti-HBc+ (HBV re...RF-PDAC-ORGAN-DYSFUNCTION- Organ dysfunction that may make standard PDAC systemic therapy unsafe.RF-PDAC-TRANSFORMATION-PROGRESSION- Rapid progression in PDAC: clinical decline + CA19-9 doubling within 4-8 weeks during 1L...RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in the STK11 (LKB1) gene — Peut...RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of Peutz-Jeghers syndrome (PJS): any of (a) a family member wi...RF-VHL-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of Von Hippel-Lindau (VHL) disease: any of (a) a family member...