Allen L. Cohn, MD, medical oncologist, Rocky Mountain Cancer Centers, discusses frontline therapies in metastatic pancreatic cancer.

For many years, the frontline standard of care in metastatic pancreatic cancer was gemcitabine monotherapy. Subsequently, FOLFIRINOX was introduced into the paradigm. Although the regimen can induce high response rates, it has a high incidence of toxicity. Then, the combination of gemcitabine and nab-paclitaxel (Abraxane) was found to show similar efficacy to that of FOLFIRINOX in the frontline setting. Although the combination has shown a lower response rate than what has been seen with FOLFIRINOX, it has a lower rate of toxicity, explains Cohn.

In terms of adjuvant chemotherapy, gemcitabine was the mainstay for many years. However, as in the frontline setting, FOLFIRINOX was found to be superior to gemcitabine monotherapy in terms of overall survival and progression-free survival, concludes Cohn.

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Dr. Cohn on Frontline Therapies in Metastatic Pancreatic Cancer

Allen L. Cohn, MD, medical oncologist, Rocky Mountain Cancer Centers, discusses the use of neoadjuvant chemotherapy in the treatment of patients with locally advanced pancreatic cancer.

Neoadjuvant chemotherapy is not a standard of care in patients with locally advanced pancreatic cancer, but it is becoming prevalent in those with borderline resectable disease, says Cohn. The goal of neoadjuvant chemotherapy is to shrink tumors, subsequently enabling a successful R0 resection and improved overall survival.

Several studies are now also looking at giving neoadjuvant chemotherapy and radiation followed by adjuvant chemotherapy in patients with locally advanced disease as an alternative approach. Recent data from investigators at the Mayo Clinic suggest that among patients who receive neoadjuvant chemotherapy, those whose CA-19-9 levels normalize and patients who complete the full course of treatment have improved survival approaching 60 months, concludes Cohn.

Allen L. Cohn, MD

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Dr. Cohn on Frontline Therapies in Metastatic Pancreatic Cancer

Dr. Cohn on Neoadjuvant Chemotherapy in Locally Advanced Pancreatic Cancer