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Learning to Navigate the Neoadjuvant and Adjuvant Paradigms in Pancreatic Cancer

Caroline Seymour
Published: Monday, Jun 11, 2018

Tanios Bekaii-Saab, MD

Tanios Bekaii-Saab, MD

Neoadjuvant chemotherapy could become a standard approach for patients with resectable pancreatic cancer, with data suggesting that adjuvant regimens also have a place in the paradigm, said Tanios Bekaii-Saab, MD, a medical oncologist at Mayo Clinic.

State of the Science Summit™ on Gastrointestinal Cancers, Bekaii-Saab discussed neoadjuvant and adjuvant strategies in treating patients with early-stage pancreatic cancer.

OncLive: Please provide an overview of your presentation on pancreatic cancer.

Bekaii-Saab: The subject I discussed [focused on] understanding the landscape of adjuvant versus neoadjuvant therapy in pancreas cancer. We know that about 10% to 15% of patients will present with advanced nonmetastatic pancreas cancer in the adjuvant setting. These patients have either resectable, borderline resectable, or locally advanced nonmetastatic disease. Most, if not all, of those patients whose tumors are clearly resectable will ultimately end up in surgery. About half of patients with borderline resectable [tumors will go to surgery], and about 10% to 15% of patients with locally advanced disease will go to surgery.

How should physicians better incorporate chemotherapy into treatment?

For adjuvant therapy, we have data for patients with resectable disease. Based on the ESPAC-4 study, we know that chemotherapy in the form of capecitabine and gemcitabine should be our standard. In the United States, we should probably use lower doses of capecitabine than used in the ESPAC-4 trial by the Europeans because of the history of capecitabine in this country versus in Europe.

Does radiation therapy have a defined role in treatment?

Radiation does not have a defined role yet. There are studies that have reported positive findings, negative findings, and in between. At this point in time, radiation does not seem to have a role, although it is still being explored in the adjuvant setting. Patients with very clear resectable disease go to adjuvant therapy. Borderline resectable and locally advanced disease certainly necessitate neoadjuvant therapy, typically in the form of chemotherapy.
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