American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for metastatic pancreatic cancer?

1. Chemotherapy with single-agent gemcitabine

2. Multiagent systemic chemotherapy with FOLFIRINOX

3. Radiation therapy alone

4. Active surveillance

The correct answer is: Multiagent systemic chemotherapy with FOLFIRINOX

For metastatic pancreatic cancer, the standard treatment involves multiagent systemic chemotherapy, specifically with a regimen known as FOLFIRINOX. This combination includes fluorouracil, leucovorin, irinotecan, and oxaliplatin, and is preferred due to its potential to improve survival rates compared to other treatment options. FOLFIRINOX is particularly appropriate for patients who have a good performance status, as it is a more intensive approach that can yield better outcomes than single-agent therapies. It allows for a comprehensive attack on the cancer with multiple agents working synergistically to inhibit tumor growth. While single-agent gemcitabine has historically been used, it has been shown to be less effective than FOLFIRINOX in treating metastatic pancreatic cancer, especially in patients who can tolerate aggressive chemotherapy. Radiation therapy is not typically indicated as a primary treatment for metastatic disease, and active surveillance is not an appropriate management strategy for this aggressive cancer type, which necessitates immediate therapeutic intervention.