How would Larry's treatment course align with the recent updates to the NCCN guidelines?
This gentleman is a very typical presentation of pancreas cancer, a 65-year-old man with metastatic disease involving the liver, lymph nodes, and peritoneal cavity. He has a head of pancreas cancer primary and presented with obstructive jaundice requiring a stent placement.
The treatment option of gemcitabine/nab-paclitaxel is a frontline standard of care. Options on disease progression depend on several thingspatient performance status, patient preference, what standard options are available, and what clinical trial options are available.
This gentleman went on to receive what has become a newly recognized standard in a second-line setting or in patients who have had prior gemcitabine. This combination of liposomal irinotecan, 5-FU, and leucovorin was compared to 5-FU and leucovorin on its own and also compared to single-agent liposomal irinotecan.
The triple drug combination showed an improvement in median overall survival of about 6 months compared to about 4 months for 5-FUbased therapy with toxicities such as neutropenia, diarrhea, fatigue, and nausea/vomiting. They were the major toxicities that were observed.
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.
Larry went on to receive the combination of nab-paclitaxel and gemcitabine as frontline therapy for 5 months: