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Multidisciplinary Care in Advanced Pancreatic Cancer

Panelists: Johanna Bendell, MD, Sarah Cannon Research Institute; Eileen O’Reilly, MD, Memorial Sloan-Kettering Cancer Center; John Marshall, MD, Ruesch Cancer Center at the Lombardi Comprehensive Cancer Center; George Kim, MD, University of Florida Health Oncology; Caio Max S. Rocha Lima, MD, Gibbs Cancer Center
Published Online: Wednesday, Feb 15, 2017



Transcript:

Johanna Bendell, MD:
Hello, and thank you for joining us for this OncLive Peer Exchange® titled “The Evolution of Sequencing Strategies in Pancreatic Cancer.” Advances in the treatment of pancreatic cancer have improved survival and have led clinicians to consider sequencing strategies. This OncLive Peer Exchange® panel of experts will focus on the current standard of care in advanced pancreatic cancer, neoadjuvant and adjuvant approaches, as well as the latest research likely to impact the ever-evolving treatment landscape.

I am Dr. Johanna Bendell, and I am director of the GI Cancer Program and associate director of the Drug Development Program at the Sarah Cannon Research Institute in Nashville, Tennessee. Participating today on our distinguished panel are Dr. George Kim, consultant of 21st Century Oncology at the University of Florida Health Oncology; Dr. Caio Rocha Lima, medical oncologist and associate director of Translational Research at the Gibbs Cancer Center and Research Institute in Spartanburg, South Carolina; Dr. John Marshall, the chief of the Division of Hematology-Oncology at the Georgetown University Hospital and director of the Ruesch Cancer Center at the Lombardi Comprehensive Cancer Center in Washington, DC; and Dr. Eileen O’Reilly, associate director of the David M. Rubenstein Cancer Center for Pancreatic Cancer at Memorial Sloan-Kettering Cancer Center and professor of medicine at the Weill Cornell Medical College. Thanks to this panel for joining us, and let’s begin.

Let’s set the stage for this discussion. We’re going to talk about all aspects of treatment of patients with pancreatic cancer today. And certainly, we’ve seen a lot of improvements and potential treatment regimens for pancreatic cancer patients and a lot that’s coming on the horizon for new studies. So, Eileen, just turning to you, tell us a little bit about how this treatment landscape has evolved recently.

Eileen O’Reilly, MD: So, Johanna, I think there have been a number of significant developments in the treatment of pancreas cancer in the last 5 years. We now have the advent of multi-agent cytotoxic therapy in the frontline setting. Depending on the individual and choices, in terms of side effects and schedules, we may choose either gemcitabine/nab-paclitaxel or FOLFIRINOX in the frontline setting. These have, I think, significantly added meaningful outcomes for patients. Nonetheless, we have a lot to do. More recently, we have the advent of liposomal irinotecan combined with 5-FU in the second-line setting, and that’s a landmark in that we now have an FDA-endorsed second-line option for the treatment of pancreas cancer. So, we’re clearly not there yet in this disease, but I think we’re also encouraged that some progress has happened in pancreas cancer.

Johanna Bendell, MD: Fantastic. And John, you have your cancer center at Georgetown University. Certainly, when you see patients with pancreatic cancer, it really feels like a multidisciplinary type of cancer. Can you tell us a little bit about your approach there?

John Marshall, MD: I don’t know how people pull it off without a multidisciplinary approach. It really starts with outstanding diagnostics, and that comes from GI nowadays—so they are our plumbers, our biopsiers, our endoscopic ultrasounders. You need really good imaging. Different places have different interests in CT or MRI, but you need good quality, dedicated pancreatic imaging to determine resectability or not. You need surgeons who do this all day every day. This is not a hobby surgery. You need somebody who has high volume for better outcomes. And, of course, our role in this is around the chemotherapy—you need radiation. Nowadays, it’s multimodality radiation, traditional, stereotactic, all the different pieces.

So, all of those folks from the medical side also then need to be supported by the social side—palliative care, social work, and psychiatry, nutrition—because this is an incredibly life-changing moment for these patients. We’re going to do everything we can to either cure them or keep them alive as long as possible. It’s absolutely a team sport.

Johanna Bendell, MD: Yes, you certainly need a very dedicated and large team to take care of these patients to give them that quality of life.

John Marshall, MD: I sometimes think about how cancer care is really a luxury item, and one of the reasons is not just the drugs or fancy scanners, it’s that team. If we’re going to expand cancer care around the world or to the underserved, you really need to provide it at that level. And you don’t have to go around the world, you can just look into rural parts of our country and see that they don’t have all of those parts in play conveniently for the patients out there. So, we need to figure out how to best serve those folks as well.

Johanna Bendell, MD: That’s true.

Transcript Edited for Clarity

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Transcript:

Johanna Bendell, MD:
Hello, and thank you for joining us for this OncLive Peer Exchange® titled “The Evolution of Sequencing Strategies in Pancreatic Cancer.” Advances in the treatment of pancreatic cancer have improved survival and have led clinicians to consider sequencing strategies. This OncLive Peer Exchange® panel of experts will focus on the current standard of care in advanced pancreatic cancer, neoadjuvant and adjuvant approaches, as well as the latest research likely to impact the ever-evolving treatment landscape.

I am Dr. Johanna Bendell, and I am director of the GI Cancer Program and associate director of the Drug Development Program at the Sarah Cannon Research Institute in Nashville, Tennessee. Participating today on our distinguished panel are Dr. George Kim, consultant of 21st Century Oncology at the University of Florida Health Oncology; Dr. Caio Rocha Lima, medical oncologist and associate director of Translational Research at the Gibbs Cancer Center and Research Institute in Spartanburg, South Carolina; Dr. John Marshall, the chief of the Division of Hematology-Oncology at the Georgetown University Hospital and director of the Ruesch Cancer Center at the Lombardi Comprehensive Cancer Center in Washington, DC; and Dr. Eileen O’Reilly, associate director of the David M. Rubenstein Cancer Center for Pancreatic Cancer at Memorial Sloan-Kettering Cancer Center and professor of medicine at the Weill Cornell Medical College. Thanks to this panel for joining us, and let’s begin.

Let’s set the stage for this discussion. We’re going to talk about all aspects of treatment of patients with pancreatic cancer today. And certainly, we’ve seen a lot of improvements and potential treatment regimens for pancreatic cancer patients and a lot that’s coming on the horizon for new studies. So, Eileen, just turning to you, tell us a little bit about how this treatment landscape has evolved recently.

Eileen O’Reilly, MD: So, Johanna, I think there have been a number of significant developments in the treatment of pancreas cancer in the last 5 years. We now have the advent of multi-agent cytotoxic therapy in the frontline setting. Depending on the individual and choices, in terms of side effects and schedules, we may choose either gemcitabine/nab-paclitaxel or FOLFIRINOX in the frontline setting. These have, I think, significantly added meaningful outcomes for patients. Nonetheless, we have a lot to do. More recently, we have the advent of liposomal irinotecan combined with 5-FU in the second-line setting, and that’s a landmark in that we now have an FDA-endorsed second-line option for the treatment of pancreas cancer. So, we’re clearly not there yet in this disease, but I think we’re also encouraged that some progress has happened in pancreas cancer.

Johanna Bendell, MD: Fantastic. And John, you have your cancer center at Georgetown University. Certainly, when you see patients with pancreatic cancer, it really feels like a multidisciplinary type of cancer. Can you tell us a little bit about your approach there?

John Marshall, MD: I don’t know how people pull it off without a multidisciplinary approach. It really starts with outstanding diagnostics, and that comes from GI nowadays—so they are our plumbers, our biopsiers, our endoscopic ultrasounders. You need really good imaging. Different places have different interests in CT or MRI, but you need good quality, dedicated pancreatic imaging to determine resectability or not. You need surgeons who do this all day every day. This is not a hobby surgery. You need somebody who has high volume for better outcomes. And, of course, our role in this is around the chemotherapy—you need radiation. Nowadays, it’s multimodality radiation, traditional, stereotactic, all the different pieces.

So, all of those folks from the medical side also then need to be supported by the social side—palliative care, social work, and psychiatry, nutrition—because this is an incredibly life-changing moment for these patients. We’re going to do everything we can to either cure them or keep them alive as long as possible. It’s absolutely a team sport.

Johanna Bendell, MD: Yes, you certainly need a very dedicated and large team to take care of these patients to give them that quality of life.

John Marshall, MD: I sometimes think about how cancer care is really a luxury item, and one of the reasons is not just the drugs or fancy scanners, it’s that team. If we’re going to expand cancer care around the world or to the underserved, you really need to provide it at that level. And you don’t have to go around the world, you can just look into rural parts of our country and see that they don’t have all of those parts in play conveniently for the patients out there. So, we need to figure out how to best serve those folks as well.

Johanna Bendell, MD: That’s true.

Transcript Edited for Clarity
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