Dr. Barzi on Available and Emerging Neoadjuvant Approaches in Pancreatic Cancer

Afsaneh Barzi, MD, assistant professor of clinical medicine, Norris Comprehensive Cancer Center, University of Southern California, discusses available and emerging neoadjuvant strategies for the treatment of patients with nonmetastatic pancreatic cancer.

Standard practice used to entail giving patients gemcitabine and evaluating for response. However, the response to gemcitabine is very poor and prevented many patients from going on to surgery, explains Barzi. The LAPACT trial looked at the combination of gemcitabine and nab-paclitaxel (Abraxane). The trial showed that 36% of patients responded to treatment, and about 15% went on to receive surgery.

Moreover, a meta-analysis of FOLFIRINOX studies that were done in patients with locally advanced disease showed that approximately 28% were able to go onto surgery. As chemotherapies become more potent, the chance for resection increases, explains Barzi. Therefore, when patients are staged, they should also be evaluated for resection. Though the majority of patients may not be eligible for surgery, it is worth evaluating for those who are, Barzi concludes.