Sequencing Strategies Advance Care Amid Challenges in Pancreatic Cancer

Gina Battaglia, PhD
Published: Wednesday, Jul 05, 2017
Eileen M.
O’Reilly, MD

Eileen M. O’Reilly, MD

Recent developments in the treatment of metastatic pancreatic cancer have modestly improved outcomes, but reducing morbidities associated with current therapies and developing novel therapeutics will be essential for achieving durable responses and long-term survival, according to experts who participated in an OncLive® Peer Exchange® panel.

Furthermore, the panelists agreed that caring for patients with pancreatic cancer requires a multidisciplinary approach that includes a medical team (ie, diagnostics, imaging, surgery, chemotherapy, and radiation therapy) and social services (ie, palliative care, social work, psychiatry, and nutrition). “This is an incredibly life-changing moment for these patients, and we’re going to do everything we can to either cure them or keep them alive as long as possible,” said John L. Marshall, MD. “It’s absolutely a team sport.”

Multiagent Frontline Chemotherapy

Until recently, gemcitabine monotherapy was considered the standard treatment for metastatic pancreatic cancer. Trials showing superior overall survival (OS) with gemcitabine plus nab-paclitaxel (Abraxane)1 and FOLFIRINOX2 —a 4-drug combination of leucovorin, fluorouracil (5-FU), irinotecan, and oxaliplatin—established these 2 regimens as frontline options for patients with metastatic pancreatic cancer and good performance status. Although these 2 combinations have not been directly compared in a head-to-head trial, some experts favor FOLFIRINOX for patients with high performance status because the PRODIGE 4/ ACCORD 11 trial with FOLFIRINOX demonstrated a numerically longer OS than the MPACT trial did with gemcitabine/nab-paclitaxel (11.1 vs 8.5 months).
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