Management of chemotherapy-induced adverse events in patients with metastatic pancreatic ductal adenocarcinoma: A United States-based modified Delphi consensus

Background:

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is an aggressive malignancy with a poor prognosis. Chemotherapy (CTX) regimens, including irinotecan-based combinations, are the mainstay of treatment for patients with mPDAC; however, these regimens are associated with adverse events (AEs) that may compromise clinical outcomes. Although management strategies for CTX-induced AEs are available, their application in U.S. clinical practice is inconsistent. To address this gap, a modified Delphi consensus process was undertaken.

Objectives:

• Describe the Delphi consensus methodology used to develop practical recommendations for managing CTX-induced AEs in patients with mPDAC.
• Explain key consensus recommendations for the proactive management of common CTX-induced AEs among patients with mPDAC, including diarrhea, nausea and vomiting, neutropenia, and neuropathy.
• Apply consensus recommendations to optimize AE management and improve consistency of care in clinical practice.

Methods:

A U.S.-based modified Delphi consensus process was conducted to develop evidence-based guidance statements for managing and mitigating CTX-induced AEs in patients with mPDAC. The process included 25 experts (gastrointestinal oncologists and oncology nurses), organized into a 21-member Delphi panel and a 4-member steering committee (SC). All had ≥3 years of experience in pancreatic cancer care; SC members also had ≥3 years of experience with liposomal irinotecan-based regimens. Draft statements, informed by published evidence and expert insight, were anonymously refined and approved by the SC, then voted on anonymously by the Delphi panel for up to 3 rounds. At each round, panelists indicated their level of agreement with each statement using a 5-point Likert scale and could provide feedback on any statements with which they disagreed. Consensus was defined a priori as any statement achieving a ≥50% response rate and ≥80% agreement within a voting round. Nonconsensus statements were anonymously revised by the SC based on panelist feedback and reintroduced in the next round.

Results:

Consensus was reached for all 25 draft statements that entered the first voting round (participation rate, 85.7%; agreement range, 82.4%–100.0%), eliminating the need for further rounds. These statements, covering 7 thematic areas, include recommendations on pretreatment assessment; patient and caregiver education; proactive management of diarrhea, nausea and vomiting, neutropenia, and neuropathy; and individualized approaches for higher-risk groups. For example, one diarrhea-specific statement recommends that patients with mPDAC and their caregivers receive at-home antidiarrheals with clear usage instructions, report the first loose stool, track symptoms for review, and follow reinforced dietary guidance. The statements also identify evidence gaps and priorities for future research, including the need to address disparities in AE recognition, reporting, and management.

Conclusion:

These statements, developed by a multidisciplinary panel of experts, provide practical guidance to optimize care for patients with mPDAC by improving consistency in the management of CTX-induced AEs. Although U.S.-based, these recommendations may be relevant to other regions.

Funding: Ipsen.

Prior Presentations:

Abstract published online for the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, May 29–June 2, 2026, in Chicago, IL, USA. Hussein M, et al. J Clin Oncol. 2026;44(Suppl 16):e16400. © 2026 American Society of Clinical Oncology, Inc. Reused with permission. All rights reserved.