Eileen O'Reilly, MD
Oncologists might be able to have another—and efficient and benefical—tool in their armamentarium of agents for the treatment of patients with newly diagnosed, metastatic pancreatic cancer. That is, if researchers are able to understand the road blocks of immunotherapy in this patient population, explains Eileen O'Reilly, MD, the associate director for Cinical Research, David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center.
In an interview with OncLive
, O'Reilly, discusses optimal sequencing of therapies for patients with pancreatic cancer, what potential immunotherapy has in the field, and whether the microenvironments and immune privilege within the malignancy should be understood.
OncLive: What are some factors to determine whether a patient with newly diagnosed, metastatic pancreatic cancer is going to respond better on certain therapies versus others?
: I recently gave a talk on what the optimal treatment is for frontline therapy for patients with newly diagnosed, metastatic pancreas cancer. I weighed the different choices of FOLFIRINOX or gemcitabine and nab-paclitaxel, and why one would choose one as opposed to the other.
I think this is a really practical question that faces oncologists everyday, and I think the first thing to note is that we have choices. For a long time, we didn't in this disease, so choices are a positive thing. Patient preferences are a consideration, as for some, the idea of being hooked up to a port and an infusion pump and getting treatment at home isn't so attractive, and for others, issues of alopecia for treatment is a concern. Comorbidities are a factor in terms of selection choice, whether a person has peripheral neuropathy, etc. Performance status is critical. We know that that's been reproducibly shown to impact outcomes, as has independent prognostic values, but it also predicts for treatment tolerability. Therefore, that's important.
Increasingly in pancreas cancer now that we do have choices, and we have even second-line therapies, what is coming to mind is if we should be informing our initial treatment choice by the available options in the second line. Treatment sequencing is a consideration. Pertinent these days is the issue of cost, and whether that should be a factor. It's probably not something that we routinely take into consideration, but like every aspect of medicine, it's becoming more integrated in our thinking and perhaps increasingly part of the decision-making in terms of the cost of drugs and cost of toxicities, as well as quality of life impacts.
All of those factors I think are approaches that we want to be cognizant of as we select an initial choice of therapy.
What is the most common way to go about treating metastatic pancreatic cancer? Will this change over the next 5 or 10 years?
We're certainly hopeful and optimistic that the future will change. In 2016, we have a few choices, and I think an upfront clinical trial is always a consideration for a patient with good performance status. Standard choices for patients with good performance status would be FOLFIRINOX or gemcitabine/nab-paclitaxel. A not uncommon situation for a patient with a less favorable performance status is single-agent gemcitabine, or perhaps gemcitabine plus capecitabine given that there are data supporting that regimen in metastatic disease, and even now some data in the adjuvant setting supporting that. I think, high up on the list, is a trial when possible.