Allyson Ocean, ​MD, a medical oncologist and attending physician in gastrointestinal oncology at New York-Presbyterian 

Hospital/Weill Cornell Medical Center; an associate professor of Medicine at the Weill Medical College of Cornell University; and medical oncologist at The Jay Monahan Center for Gastrointestinal Health, discusses determining the optimal frontline treatment of patients with metastatic pancreatic cancer.

For the first-line treatment of metastatic pancreatic cancer, the best first option is a clinical trial, says Ocean, especially for patients who have been diagnosed with an aggressive and hard-to-treat disease. If a clinical trial is not available or the patient does not want to participate, then a more standard treatment regimen can be considered, such as FOLFIRINOX or gemcitabine and nab-paclitaxel (Abraxane), adds Ocean.

A few factors can be used to determine the best frontline regimen for a patient with metastatic pancreatic cancer, Ocean explains, such as how fit they are, performance status, preference, quality of life, and the goals of their care. Additionally, sometimes their symptoms and whether they are in pain or have a lot of problems related to disease burden are considered. If a quicker response needs to be achieved, that may dictate choosing 1 regimen over the other, concludes Ocean.

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Allyson Ocean, ​MD, discusses determining the optimal frontline treatment of patients with metastatic pancreatic cancer.

Dr. Ocean on Determining Optimal Frontline Treatments for Metastatic Pancreatic Cancer

Allyson Ocean, ​MD, an associate attending physician, NewYork-Presbyterian Hospital, and associate professor of clinical medicine at Weill Cornell Medicine, discusses the need for additional second-line therapies in metastatic pancreatic cancer. 

FOLFIRINOX and the combination of gemcitabine plus nab-paclitaxel (Abraxane) have demonstrated survival advantages in the first-line setting for patients with metastatic pancreatic cancer, says Ocean. However, ​these patients often progress ​and require second-line therapy. 

Notably, the unmet need in this space led to the development of nanoliposomal irinotecan (Onivyde), a unique compound that can induce a prolonged response and better cell kill, Ocean concludes. 

Allyson Ocean, ​MD, discusses the need for additional second-line therapies in metastatic pancreatic cancer. 








Dr. Ocean on the Development of Nanoliposomal Irinotecan in Metastatic Pancreatic Cancer 

Allyson Ocean, MD, an associate attending physician, NewYork-Presbyterian Hospital, and associate professor of clinical medicine at Weill Cornell Medicine, discusses the impact of the phase III PRODIGE 24/CCTG PA.6 trial on patients with pancreatic cancer.

The phase III PRODIGE 24/CCTG PA.6 trial compared 2 chemotherapy regimens, FOLFIRINOX and gemcitabine, in the adjuvant setting for patients with pancreatic cancer, explains Ocean. Before the trial, the standard of care was gemcitabine alone or in combination with capecitabine; however, this trial showed positive results in favor of FOLFIRINOX as adjuvant therapy with the median overall survival approaching over 4 years, says Ocean.

This trial changed the standard of care for patients with pancreatic cancer. Now, there is a treatment regimen that has been shown to extend life significantly. Therefore, because of the significant survival advantage, eligible patients with pancreatic cancer should receive FOLFIRINOX over gemcitabine in the adjuvant setting, concludes Ocean.

Allyson Ocean, MD, discusses the impact of the phase III PRODIGE 24/CCTG PA.6 trial on patients with pancreatic cancer.

Dr. Ocean on Impact of the PRODIGE 24/CCTG PA.6 Trial in Pancreatic Cancer

Allyson Ocean, MD, an associate attending physician, NewYork-Presbyterian Hospital, and associate professor of clinical medicine at Weill Cornell Medicine, discusses the use of circulating tumor DNA (ctDNA) in pancreatic cancer.

ctDNA analysis has been done, but it is still in its infancy in terms of guiding therapy. As such, it is not being done routinely in pancreatic cancer, says Ocean. Several challenges need to be addressed before ctDNA analysis is made widely available. For example, sometimes more than the tumor DNA is sampled, which can result in confounding factors.  

Ongoing trials and experimental protocols are investigating the use of ctDNA to predict disease recurrence, as well as develop better therapies, concludes Ocean.

Allyson Ocean, MD, discusses the use of circulating tumor DNA in pancreatic cancer.

Dr. Ocean Discusses the Use of ctDNA in Pancreatic Cancer

Allyson Ocean, MD, an associate attending physician, NewYork-Presbyterian Hospital, and associate professor of clinical medicine at Weill Cornell Medicine, discusses efforts to improve early detection rates in pancreatic cancer.

Several advances have been made in earlier detection of pancreatic cancer. For example, it is now known that approximately 1% of new-onset diabetics are at risk of developing pancreatic cancer. Therefore, research is beginning to examine that patient population. Additionally, a blood test designed to detect early-stage pancreatic cancer is currently under development, adds Ocean.

Moreover, guidelines now recommend that all patients diagnosed with pancreatic cancer undergo genetic testing, as it may reveal an actionable mutation in their germline or in their tumor. Genetic testing could also reveal whether a patient has a mutation that predisposes them, and potentially their family members, to pancreatic cancer. To this end, the ongoing GENERATE study allows family members to receive free genetic testing if someine in their family has pancreatic cancer with a known genetic mutation.

Allyson Ocean, MD, discusses efforts to improve early detection rates in pancreatic cancer.

Dr. Ocean on Efforts to Improve Early Detection in Pancreatic Cancer

Allyson Ocean, MD, medical oncologist, attending physician, Gastrointestinal Oncology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, medical oncologist, The Jay Monahan Center for Gastrointestinal Health, associate professor of medicine, Weill Medical College of Cornell University, discusses ongoing research on high-dose intravenous (IV) vitamin C in 

The use of high-dose IV vitamin C is being studied in both colon cancer and pancreatic cancer. The way that vitamin C targets the 

-mutated cell is through the Warburg effect in which cells travel through a pathway where their energy metabolism is affected when they receive high-dose vitamin C. In a sense, it is a metabolic killing of the cell, forcing the cells into oxidative phosphorylation rather than the glycolytic pathway.

-mutated cancers is currently on trial as a pilot at Weill Cornell Medicine.

Allyson Ocean, MD, medical oncologist, attending physician, Gastrointestinal Oncology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, medical oncologist, The Jay Monahan Center for Gastrointestinal Health, associate professor of medicine, Weill Medical College of Cornell University, discusses ongoing research on high-dose intravenous (IV) vitamin C in KRAS-mutated cells.

Dr. Ocean on the Mechanism of Action of High-Dose Vitamin C in KRAS Mutations

Allyson Ocean, MD, medical oncologist, attending physician, Gastrointestinal Oncology, Weill Cornell Medicine/New York-Presbyterian Hospital, medical oncologist, The Jay Monahan Center for Gastrointestinal Health, associate professor of medicine, Weill Medical College of Cornell University, discusses emerging anti-stromal agents in pancreatic cancer.

One of the reasons why pancreatic cancer therapies fail is because they can’t penetrate fibroblast-enriched stroma that are devoid of immune cells. We now know from previously reported research that the vitamin D receptor is very important in the stroma.

The activation of the vitamin D receptor relates to the pancreatic stellate cell, which is responsible for the immune cross talk and signaling that happens within pancreatic cancer in the stroma. Research has shown that inhibiting the vitamin D receptor with vitamin D analogs can turn the stellate cell into a less active cell. This can ultimately bring more immune cells into the stroma and allow for better penetration with chemotherapy.

Allyson Ocean, MD

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