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Pancreatic Cancer Case Studies

George P. Kim, MD: Expected Response with Liposomal Irinotecan

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 level of response would you anticipate with the liposomal irinotecan regimen for this patient, based on data published in The Lancet earlier this year?

This patient was treated with nab-paclitaxel and gemcitabine and then goes on to the nal-IRI regimen. The clinical benefits that patients experienced was about a 2-month improvement in overall survival. The numbers were 6.1 versus 4.2 months. One-year survival was 24% versus 17% in the 5-FU alone arm, so there are clearly survival benefits in the second-line. In terms of progression-free survival (PFS), there was a doubling of PFS, so again, that may translate into a prolongation of stable disease and perhaps symptom control. Response rates were low at 8%, but, because it was a second-line treatment, that was much higher than what was seen in the control arm. There may be some symptom improvement with this regimen as well, but the response rate is only 8%. Very clearly, patients benefit. There is a clinical benefit and it’s meaningful.

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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