ONCAlert | 2017 San Antonio Breast Cancer Symposium
Pancreatic Cancer Case Studies

George P. Kim, MD: Options for Patient Going Forward

George P. Kim, MD
Published Online:Sep 23, 2016
Henry R was diagnosed with adenocarcinoma in the body of the pancreas when he was 64 years old, following rapid weight loss, abdominal pains, and the development of venous thrombosis. 

Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 2

Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 1
Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 2


What are the options for this patient going forward? Do you recommend a third-line therapy?

If this patient has a good performance status, then yes, he can go on to third-line therapy. In this situation, patients receive a taxane and then irinotecan, and so logically one could consider a clinical trial, a phase I study, or perhaps a -platin. Oxaliplatin can be used in this situation, dependent on whether the patient has any residual neuropathy from nab-paclitaxel that was given in the frontline. The good news there is that the neuropathy can be reversible in the majority of patients, so hopefully by the time they’ve worked through their first-line, second-line, and now the third-line, the neuropathy will be more manageable so the patient can go on a drug such as oxaliplatin. The other option is to go on cisplatin, which does provide benefit. There are other chemotherapies that can be used, but we have a limited numbers of options at that time. But those are some considerations for third-line treatment.

Metastatic Pancreatic Cancer: Case 2

Henry R was diagnosed with adenocarcinoma in the body of the pancreas when he was 64 years old, following rapid weight loss, abdominal pains, and the development of venous thrombosis. 

  • At diagnosis, measurable distant lymph node, liver, and lung metastases were observed
  • His CA19-9 level was 2760 U/ml and his concentration of albumin was 28 g/L. His ECOG performance status was 1.

Upfront treatment was administered with nab-paclitaxel and gemcitabine, which lasted for 4months:

  • At the time of progression, pain levels had increased interfering with daily activity and raising the ECOG performance status to a 2.
  • At this point, second-line therapy was initiated with liposomal irinotecan, fluorouracil, and folinic acid.
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