Eileen M. O'Reilly, MD: Impact of Effective Therapies on Treatment

How has the availability of effective therapies shifted the treatment paradigm for patients with pancreatic cancer?

We have a frontline option, we have a second-line option, and for some patients we have a third-line option in terms of standard choices. I think we are considering more and more what’s available as the backup option in terms of how we select our frontline choice. Our sense is that all of the treatment that’s delivered contributes to the best outcome and we know that in colon cancer, for example, that giving all the active drugs—5-FU, oxaliplatin, irinotecan, the biologics—that having access to those for an individual patient maximizes the chances of the best outcome. We don’t have black and white data yet that would support that statement in pancreas cancer but I think it’s coming as we integrate more and more second-line therapies and, increasingly, our discussion on third-line therapy for patients.

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.