ONCAlert | 2018 ASCO Annual Meeting
Pancreatic Cancer Case Studies

George P. Kim, MD: Aligning Treatment With Updates in NCCN Guidelines

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


How would Henry's treatment course align with the recent updates to the NCCN guidelines?

Henry was treated with a gemcitabine-based combination in the frontline setting. He was given gemcitabine/nab-paclitaxel, and he benefitted, but, unfortunately, his tumor progressed. His symptoms progressed, and so a change in his treatment is needed. According to the NCCN guidelines and recommendations, based on his receiving a gemcitabine-based treatment up front, Henry should go on to a clinical trial or a 5-FU–based treatment and that could include a drug called Onivyde or MM-398, the nal-IRI regimen. That is a regimen that brings forward a new drug that was just FDA approved in October 2015. It’s a very smart drug. It has 80,000 irinotecan molecules in it and stays longer in the circulation and has shown survival benefit. Now, the other aspect of Henry’s case is that he’s having pain, which really highlights to me the importance of managing these patients. Pancreas cancer patients are unlike other cancer patients. They have to deal with the pain, they have to deal with nutritional challenges, blood clot risks, all sorts of additional challenges that most cancer patients don’t face. The bile ducts have to be maintained. He has to have good biliary function. He may need a stent. Liver enzymes have to be normal. This is very important in the use of taxanes and irinotecan in treatment. For both of these combinations, you have to have near normal bilirubin and near normal hepatic function for MM-398/Onivyde, as well as for nab-paclitaxel.

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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