The document discusses recommendations from the NCCN Guidelines for Pancreatic Adenocarcinoma panel regarding the inclusion of several drugs as subsequent treatment options for pancreatic cancer. The panel voted to include adagrasib, dostarlimab-gxly, nivolumab plus ipilimumab, and sotorasib as treatment options for patients with certain mutations and performance statuses based on reviews of clinical trial data.

1. NCCN Guidelines for Pancreatic Adenocarcinoma V.1.2023 – Annual on 03/16/2023
Guideline Page
and Request
Panel Discussion/References
Institution Vote
YES NO ABSTAIN ABSENT
PANC-F (8 of 12)
Internal request:
Comment to consider the inclusion of adagrasib as a
subsequent treatment option for patients with KRAS
G12C-mutation positive locally advanced, metastatic,
or recurrent pancreatic adenocarcinoma for Good PS
0-1.
Based on the review of the data, the panel
consensus was to include adagrasib as a subsequent
treatment option for patients with KRAS G12C-
mutation positive locally advanced, metastatic, or
recurrent pancreatic adenocarcinoma and Good PS
0-1. This is a category 2A, useful in certain
circumstances recommendation.
22 1 4 6
PANC-F (8 of 12)
External request:
Submission from GSK (06/28/2022) to include
dostarlimab-gxly as a subsequent therapy for locally
advanced/metastatic or recurrent mismatch repair
deficient (dMMR) pancreatic carcinoma.
Based on review of the data in the noted references,
the panel consensus was to include dostarlimab-gxly
as a subsequent treatment option for patients with
MSI-H or dMMR locally advanced, metastatic, or
recurrent pancreatic adenocarcinoma and Good PS
0-1. This is a category 2A, other recommended
recommendation.
See submission for references.
21 1 5 6
PANC-F (8 of 12)
External request:
Submission from Bristol Myers Squibb (04/11/2022) to
include nivolumab in combination with ipilimumab as a
treatment option for patients with tissue TMB-H (tTMB-
H) pancreatic adenocarcinoma who are refractory to
standard therapies or have no standard treatment
options available.
Based on review of the data in the noted references,
the panel consensus was to include nivolumab in
combination with ipilimumab as a subsequent
treatment option for patients with tissue TMB-H >10
mut/Mb locally advanced, metastatic, or recurrent
pancreatic adenocarcinoma who are refractory to
standard therapies or have no standard treatment
options available and Good PS 0-1. This is a
category 2B, Other Recommended recommendation.
19 4 4 6

2. NCCN Guidelines for Pancreatic Adenocarcinoma V.1.2023 – Annual on 03/16/2023
PANC-F (8 of 12)
External request:
Submission from Amgen, Inc. (02/17/2022) to include
sotorasib monotherapy for treatment of patients with
metastatic KRAS G12C-mutated pancreatic cancer
who have received prior therapy.
Based on the review of the data in the noted
references, the panel consensus was to include
sotorasib as a subsequent treatment option for
patients with KRAS G12C-mutation positive locally
advanced, metastatic, or recurrent pancreatic
adenocarcinoma and Good PS 0-1. This is a
category 2A, useful in certain circumstances
recommendation.
See submission for references.
23 0 4 6
PANC-F (9 of 12)
Internal request:
Comment to consider the inclusion of adagrasib as a
subsequent treatment option for patients with KRAS
G12C-mutation positive locally advanced, metastatic,
or recurrent pancreatic adenocarcinoma for
Intermediate PS 2 and Poor PS 3-4.
Based on the review of the data, the panel
consensus was to include adagrasib as a subsequent
treatment option for patients with KRAS G12C-
mutation positive locally advanced, metastatic, or
recurrent pancreatic adenocarcinoma and:
1. Intermediate PS 2. This is a category 2A, useful
in certain circumstances recommendation.
2. Poor PS 3-4. This is a category 2B, useful in
certain circumstances recommendation.
20
12
2
9
5
6
6
6
PANC-F (9 of 12)
External request:
Submission from GSK (06/28/2022) to include
dostarlimab-gxly as a subsequent therapy for locally
advanced/metastatic or recurrent mismatch repair
deficient (dMMR) pancreatic carcinoma.
Based on review of the data in the noted references,
the panel consensus was to include dostarlimab-gxly
as a subsequent treatment option for patients with
MSI-H or dMMR locally advanced, metastatic, or
recurrent pancreatic adenocarcinoma and:
1. Intermediate PS 2. This is a category 2A,
useful in certain circumstances
recommendation.
2. Poor PS 3-4. This is a category 2B, preferred
regimen recommendation.
See submission for references.
20
12
2
9
5
6
6
6

3. NCCN Guidelines for Pancreatic Adenocarcinoma V.1.2023 – Annual on 03/16/2023
PANC-F (9 of 12)
External request:
Submission from Bristol Myers Squibb (04/11/2022) to
include nivolumab in combination with ipilimumab as a
treatment option for patients with tissue TMB-H (tTMB-
H) pancreatic adenocarcinoma who are refractory to
standard therapies or have no standard treatment
options available.
Based on review of the data in the noted references,
the panel consensus was to include nivolumab in
combination with ipilimumab as a subsequent
treatment option for patients with tissue TMB-H >10
mut/Mb locally advanced, metastatic, or recurrent
pancreatic adenocarcinoma who are refractory to
standard therapies or have no standard treatment
options available and Intermediate PS 2. This is a
category 2B, useful in certain circumstances
recommendation.
18 5 4 6
PANC-F (9 of 12)
External request:
Submission from Amgen, Inc. (02/17/2022) to include
sotorasib monotherapy for treatment of patients with
metastatic KRAS G12C-mutated pancreatic cancer
who have received prior therapy.
Based on the review of the data in the noted
references, the panel consensus was to include
sotorasib as a subsequent treatment option for
patients with KRAS G12C-mutation positive locally
advanced, metastatic, or recurrent pancreatic
adenocarcinoma and:
1. Intermediate PS 2. This is a category 2A, useful
in certain circumstances recommendation.
2. Poor PS 3-4. This is a category 2B, useful in
certain circumstances recommendation.
22
15
0
7
5
5
6
6