American Board of Internal Medicine (ABIM) Certification Practice Exam

What is considered the initial therapy for metastatic pancreatic cancer?

1. Single-agent gemcitabine

2. Chemotherapy involving FOLFIRINOX

3. Surgical resection

4. Radiation therapy

The correct answer is: Chemotherapy involving FOLFIRINOX

In the management of metastatic pancreatic cancer, the initial therapy often involves chemotherapy, and FOLFIRINOX is a commonly recommended regimen for patients who are well enough to tolerate it. FOLFIRINOX consists of a combination of four chemotherapeutic agents: fluorouracil, leucovorin, irinotecan, and oxaliplatin. This regimen has been shown to improve overall survival compared to other treatments in clinical trials, particularly for patients with good performance status. The rationale behind choosing FOLFIRINOX as the initial therapy is based on its efficacy in providing a more aggressive treatment approach that can enhance outcomes in certain populations, particularly younger patients or those without significant comorbidities. The combination of drugs not only targets the cancer more effectively but also has been associated with a higher response rate than single-agent therapies. On the other hand, while single-agent gemcitabine may be an option for some patients, it is generally considered to have a lower efficacy compared to combination therapies like FOLFIRINOX. Surgical resection is not a feasible option for metastatic disease, as it is typically reserved for localized tumors that can be completely excised. Radiation therapy is usually not a first-line treatment for metastatic pancreatic cancer; it may