ONCAlert | 2018 ASCO Annual Meeting
Pancreatic Cancer Case Studies

Eileen M. O'Reilly, MD: Diagnosing Patients With Pancreatic Cancer at an Earlier Stage

Eileen M. O'Reilly, MD
Published Online:Sep 09, 2016
Larry D, a 62-year-old, presented to his primary care physician with persistent pain in his epigastric region, and was later diagnosed with metastatic pancreatic cancer. 

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


What can be done to help diagnose patients like Larry at an earlier stage?

That’s a huge challenge. I think if we’re to make a substantial impact in this disease, this is the area where it’s going to come from, in terms of early detection and being able to screen for pancreas cancer. Being able to screen is one thing, but recognizing who’s at risk for this disease is another. We do have some clues, and some lifestyle contributions contribute to the development of this disease. But perhaps several areas where opportunities exist are people with a genetic predisposition to pancreas cancer, so a subset of people who have a familial risk for this disease based on either a known genetic entity in that individual or in their family. They’re groups of people that we might want to target. Individuals who develop diabetes without lifestyle considerations, or without a family history of diabetes, that’s a red flag that there could be something underpinning this. We have some lead time there, in that diabetes may predate the identification of this disease by several years sometimes, and that could be an opportunity in terms of screening for this cancer.

The problem is that our tools for screening detect this malignancy when it’s an established entity, and we really want to be able to detect it before it’s become an invasive cancer. There are a lot of investigations underway looking at imaging prospects, looking at mutated genes as a prodrome for this disease, looking at altered amino acids that might be detectable several years prior to the identification of this disease. There’s a lot of focus on this, and I think it’s a very worthy effort but we are still a long way from saying that we can screen for pancreas cancer and that we can impact our ability to detect this disease early and longevity, which are our ultimate goals.

Metastatic Pancreatic Cancer: Case 1

Larry D, a 62-year-old, presented to his primary care physician with persistent pain in his epigastric region, which persists throughout the night. Within the past 2 years, he has developed diabetes and experienced considerable weight loss with signs of depression. 

  • During his visit, jaundice was observed along with periumbilical subcutaneous metastases.
  • Testing revealed an elevated CA19-9 level (2293 U/ml).
  • CT scan showed a large mass on the head of the pancreas, and a subsequent biopsy showed the mass to be adenocarcinoma. Liver and local lymph note metastases were identified.

Larry went on to receive the combination of nab-paclitaxel and gemcitabine as frontline therapy for 5 months:

  • Upon progression, Larry was switched to the combination of liposomal irinotecan, fluorouracil, and folinic acid. Treatment failure occurred after 2.5 months.
  • Larry received FOLFOX as a third-line treatment.
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.