Multiagent systemic chemotherapy, with a preferred regimen of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX), is most appropriate for this patient, who has a history of stage II pancreatic cancer and now has developed a metastatic recurrence. Patients with pancreatic cancer remain at substantial risk of developing a metastatic recurrence within the first 2 years after undergoing appropriate surgical resection (Whipple procedure). For such patients who are otherwise medically fit and have good performance status, FOLFIRINOX chemotherapy is associated with improved outcomes compared with single-agent chemotherapy. More recently, the combination of nab-paclitaxel and gemcitabine has been shown to be modestly superior to gemcitabine alone.

Gemcitabine as single-agent therapy would be suitable for a patient with metastatic pancreatic cancer who is more debilitated (poor performance status) than the patient described here.

Radiation therapy to the liver might be appropriate for treatment of locally symptomatic liver disease but would not be effective for management of metastatic pancreatic cancer in a patient who is otherwise a good candidate for systemic chemotherapy.

Transarterial chemoembolization is used for treatment of metastatic lesions to the liver associated with a number of different cancers. It is most effective in treating larger, symptomatic metastatic lesions, but does not address systemic disease and would not be expected to be as effective as multiagent systemic chemotherapy.