Current Therapeutic Advances in Metastatic Pancreatic Cancer - Episode 4

Optimizing Treatment of Advanced Pancreatic Cancer

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On average, 20% to 25% of patients with pancreatic cancer are candidates to undergo a Whipple procedure (pancreaticoduodenectomy), which extends survival; however, the recurrence rate following this procedure is 85% at 2 years, notes Francis P. Arena, MD. Moreover, the 5-year survival rate for patients with pancreatic cancer is less than 5%, Arena notes.

In an attempt to improve outcomes, the combination of gemcitabine and nab-paclitaxel is being explored in the adjuvant setting, based on the combinations efficacy in the metastatic space, notes Arena. This phase II single-arm study will assess recurrence-free survival as a primary endpoint with overall survival as a secondary outcome measure.

In addition to the exploration of adjuvant therapies, researchers are exploring the optimization of treatments for patients with locally advanced pancreatic cancer. In the phase III LAP 07 study, chemoradiotherapy was compared to chemotherapy in patients with stable disease following 4 months of gemcitabine with or without erlotinib. Following the 4 months of initial treatment, patients received 2 months of radiation plus capecitabine or capecitabine alone.

This study provided two surprising outcomes, notes E. Gabriela Chiorean, MD. Overall, the addition of radiation did not improve progression-free survival or overall survival. Moreover, Chiorean adds, the utilization of erlotinib plus gemcitabine in the locally advanced setting may actually worsen outcomes. The OS for patients receiving chemotherapy alone, without radiation or erlotinib, was approximately 16 months, notes Chiorean. However, in patients who received erlotinib and radiation therapy, the OS was approximately 13.5 months. These data suggest that optimal results can be achieved using chemotherapy alone for the treatment of patients with locally advanced pancreatic cancer, Chiorean states.