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Emerging Agents May Fill Therapeutic Gap in Metastatic Pancreatic Cancer

Caroline Seymour
Published: Sunday, Mar 10, 2019

Niharika B. Mettu, MD, PhD

Niharika B. Mettu, MD, PhD

Since establishing FOLFIRINOX and the combination of gemcitabine and nab-paclitaxel (Abraxane) as frontline therapy for patients with metastatic pancreatic cancer, investigators have been hard-pressed to find alternative agents with the potential for improved survival—until recently, explained Niharika B. Mettu, MD, PhD.

State of the Science Summit™ on Gastrointestinal Cancers, Mettu, an assistant professor of medicine at Duke Cancer Institute, discussed frontline approaches, maintenance therapy, sequencing strategies, and emerging agents for patients with newly diagnosed metastatic pancreatic cancer.

OncLive: What are the standard frontline therapies for patients with metastatic pancreatic cancer?

Mettu: We have two first-line treatments for patients with metastatic pancreatic cancer. It really gets to what their performance status is. For patients with good performance status, FOLFIRINOX and gemcitabine/nab-paclitaxel are the 2 category 1 recommendations in the National Comprehensive Cancer Network (NCCN) guidelines.

Have any notable advances been made in this setting?

It's a tough space. We currently have a clinical trial that's open right now in the frontline setting. We need more advances in the frontline setting. There was an exciting phase I paper published in Lancet Oncology on CPI-613 in combination with FOLFIRINOX, which had some impressive results. It's currently in an ongoing phase III study, so we'll have to see if that [combination will] provide any additional benefit.

What was the rationale for the study?

CPI-613 has a novel mechanism of action that is different from the other drugs that we use. It works on the tricarboxylic acid cycle and inhibits 2 different enzymes. It's a lipoate analog; it's different from standard cytotoxic chemotherapy, and that's what we need in pancreatic cancer. We need something novel that will make a difference for our patients rather than just standard cytotoxic combinations.

Moving to maintenance therapy, what was the rationale for the PRODIGE-35 trial?

Our patients who are on these aggressive regimens derive survival benefit, but not without toxicity. As such, the idea behind this study was to look at ways of administering therapy so that patients could have continued benefit with minimal toxicity.
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