In this continuing medical education video session, Dr. Tanios Bekaii-Saab tells us, “in the last 30 years, overall five-year relative survival rates increased for most cancers except for lung and pancreatic cancers, which have shown the least improvement.”
In terms of mortality, pancreatic cancer is the fourth leading type of cancer death for both men and women in the United States, accounting for a total of approximately 36,800 deaths in 2010. Dr. Bekaii-Saab explains the timeline of studies of both monotherapy and combination therapies in the treatment of this aggressive and debilitating disease.
Dr. Bekaii-Saab, MD, FACP from the Ohio State University James Cancer Hospital takes us through current modes of treatment, results of recent clinical trials, and offers insight on the future of treatments for MPCA patients in this On Demand CME offering from OMEDLive, “Determining Optimal Treatments for Patients with Metastatic Pancreatic Cancer (MPCA).”
Performance Status is Critical
Dr. Bekaii-Saab supports a study that shows performance status as the critical determinant in who will benefit from combination chemotherapy. Lower Eastern Cooperative Onconlogy Group (ECOG) scores indicate improved outcomes for combination therapies versus monotherapies.
Targeted Agents for Pancreatic Cancer (MPCA)
Although targeted chemotherapy agents are widely used to treat most types of cancer, Dr. Bekaii-Saab explains that one option, Erlotnib, confers at best a “marginal survival benefit.” He gives alternative treatment protocols with data supporting improved outcomes, at some levels, for these patients.
Trials of Gemcitabine + nab-Paclitaxel
Dr. Bekaii-Saab and host Dr. Eileen M. O’Reilly, MD from Memorial Sloan Kettering Cancer Center describe the Phase III MPACT Trial of Gemcitabine + nab-Paclitaxel in MPCA patients, paying special attention to overall survival (OS) rates, progression free survival (PFS), and safety/adverse events. Dr. Bekaii-Saab said there are modifications that can be made to the typical regimen that can lead to improved OS rates in some patients.
New Options Available
Dr. Bekaii-Saab goes in-depth on the study of FOLFIRINOX vs. Gemcitabine as a first line treatment for MPCA. In his discussion, Dr. Bekaii-Saab shows comparative outcomes, efficacy related to OS and PFS, and toxicity events. The conversation expands to also involve the comparison of FOLFIRINOX vs. the combination therapy of Gemcitabine + nab-Paclitaxel.
MM-398, Nanoliposoma Irinotecan (nal-IRI) is also relatively new and can deliver higher concentration of irinotecan and SN-38 into pancreatic cancer tumors without increasing the toxic effects of either medication.
Selected New Agents in Development
Because of the way the pancreatic cancer tumors develop, their environment is hypoxic. It is partially this condition that limits the use of many other chemotherapies. Currently in trial phases, a hypoxia-activated prodrug TH-302 seeks to be able to mitigate this challenge. In the Phase III MASTRO Trial, 660 patients with metastatic or locally advanced unresectable pancreatic cancer are undergoing treatment with Gemcitabine or a combination of Gemcitabine and TH-302.
Other agents being studied in combination include Capecitabine + Ruxolitinib versus Capecitabine as a stand-alone treatment. During the video presentation, Dr. Bekaii-Saab says using this is a two-pronged approach: 1) to help control tumor growth and spread, and 2) to improve weight loss or at least top the process of cachexia.
While biomarkers are typically standard in the treatment of cancers, Dr. Bekaii-Saab states there are, “no predictive biomarkers for MPCA” but there are several prognostic biomarkers that should be recognized.
Palliative Care and Symptom Control
Dr. Bekaii-Saab reminds us,
“Pancreatic cancer patients are very sick, as we know. They come to us with a lot of symptoms,
and a lot of them can overlap or be confused with therapy related symptoms.”
In the final section of the presentation Dr. Bekaii-Saab reminds us MPCA patients need more complex care as it relates to palliative care and symptom control secondary to the fact that their disease process has a wide range of symptoms including pain, biliary obstruction, cachexia, diabetes, and fatigue, just to name a few.
Finally, pain management is a real issue for MPCA patients. Dr. Bekaii-Saab recommends starting patients on analgesics at Level III or Level IV on the World Health Organization Analgesia Ladder.
Watch Dr. Bekaii-Saab and Dr. Eileen M. O’Reilly discuss this topic for CME credit on OMEDLive during their presentation “Determining Optimal Treatments for Patients with Metastatic Pancreatic Cancer (MPCA).”
Disclaimer: All PlatformQ Health articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.