Nilofer S. Azad, M
The incidence of pancreatic cancer is on the rise—a phenomenon that can only be counteracted by better diagnostics and therapeutic strategies, explained Nilofer Saba Azad, MD, an associate professor of oncology at Johns Hopkins Medicine.
However, data from 3 recent pivotal trials have influenced practice and/or warrant consideration when treating patients with localized disease, said Azad.
Historically, the standard of care for patients with resectable or borderline resectable tumors has been surgery followed by adjuvant chemotherapy. Although prior studies that have suggested the benefit of neoadjuvant therapy have been mainly observational in nature, the data were enough to warrant further exploration, explained Azad.
Now that FOLRINOX has become the optimal regimen in pancreatic cancer, the question of whether or not it can replace gemcitabine in combination with chemoradiation remains unknown, said Azad. Nonetheless, this study provides clinicians with preliminary phase III data to support giving chemoradiation preoperatively.
In 2013, the combination of gemcitabine and nab-paclitaxel (Abraxane) showed a survival benefit compared with single-agent gemcitabine in patients with advanced disease. As such, the nonrandomized phase II LAPACT trial2
was designed to assess the safety and efficacy of 6 cycles of induction therapy with the combination in patients with locally advanced treatment-naïve disease.
In the induction phase of the trial, 106 patients received 125 mg/m2
of nab-paclitaxel in combination with 1000 mg/m2
of gemcitabine days 1, 8, and 15 of each 28-day cycle for up to 6 cycles, after which patients were able to continue on the prespecified treatment, begin chemoradiation, or undergo surgical resection, if eligible. Of the 61 patients who completed induction therapy, 45 went on to receive investigator’s choice of nab-paclitaxel/gemcitabine (n = 12), chemoradiation (n = 17), or surgery (n = 16).
“No matter which approach you take, you have preserved quality of life (QoL),” said Azad.
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