Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, director of the Phase I Program, City of Hope, discusses findings from a pilot study (NCT02336087) evaluating the safety of adding dietary supplements to chemotherapy in patients with unresectable pancreatic cancer.

The study enrolled 21 patients to receive 17 supplements in the form of 12 pills and 2 smoothie packets with metformin and gemcitabine plus nab-paclitaxel (Abraxane).

The overall survival and progression-free survival were 8.9 months and 5.4 months respectively. A partial response rate of 29% was observed with the chemotherapy/supplement combination. These results were comparable to findings from the randomized phase III MPACT trial, says Chung.

Investigators also evaluated the safety of this regimen as many patients with pancreatic cancer experience gastrointestinal toxicities with treatment, explains Chung. Findings revealed that the treatment was generally well tolerated; only 2 patients came off study early.

Some patients who received the supplement/chemotherapy combination reported higher energy levels and a general improvement in well-being, explains Chung. As such, further investigation is needed to determine if supplements can improve patients

Videos

Vincent Chung, MD, discusses findings from a pilot study evaluating the safety of adding dietary supplements to chemotherapy in patients with unresectable pancreatic cancer.

Dr. Chung on Adding Dietary Supplements to Chemotherapy in Pancreatic Cancer

Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, director of the Phase I Program, City of Hope, discusses the importance of genomic testing in pancreatic cancer.

While actionable mutations are rare in patients with advanced disease, there are targeted agents that are approved for use in the space, explains Chung. For example, larotrectinib (Vitrakvi) was approved in November 2018 for the treatment of patients with solid tumors who harbor an 

Additionally, immunotherapy should be considered for the 1% to 2% of patients with pancreatic cancer who have microsatellite instability—high disease, says Chung.

The National Comprehensive Cancer Network guidelines recommend that patients with advanced pancreatic cancer undergo genomic testing. Moreover, all patients with pancreatic cancer should receive germline testing, concludes Chung.

Vincent Chung, MD, discusses the importance of genomic testing in pancreatic cancer.



Dr. Chung on the Importance of Genomic Testing in Pancreatic Cancer

Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, director of the Phase I Program, City of Hope, discusses the effect of gemcitabine, nab-paclitaxel (Abraxane), metformin, and dietary supplements on patients with pancreatic cancer.

Researchers looked at overall survival (OS) and response rates of patients during the trial. The average OS was 8.9 months and 29% of patients responded to therapy. This is comparable with the IMPaCT trial which is a large, randomized, phase III clinical trial that looked at nab-paclitaxel plus gemcitabine in pancreatic cancer, says Chung.

This was a safety study evaluating if patients are able to tolerate taking these supplements on a regular basis in combination with chemotherapy. Patients with pancreatic cancer commonly have gastrointestinal (GI) problems. The study found that this regimen was feasible, although 1 patient did discontinue supplements due to the volume of supplements but not GI toxicity. Anecdotally, many of the patients said their symptoms improved, such as an increase in energy, concludes Chung.

Vincent Chung, MD, discusses the effect of gemcitabine, nab-paclitaxel (Abraxane), metformin, and dietary supplements on patients with pancreatic cancer.

Dr. Chung on the Effect of Combo Therapies in Patients With Pancreatic Cancer

Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, director of the Phase I Program, City of Hope, discusses the COMPASS trial in pancreatic cancer.

The most exciting trial that came out of the 2019 Gastrointestinal Cancer Symposium was the COMPASS trial, says Chung. COMPASS was a prospective trial that was conducted in Canada in which patients who were undergoing frontline therapy underwent concurrent tumor tissue biopsy and sequencing. Investigators did RNA sequencing as well as patient-derived organoids, results of which were received an average of 39 days later, says Chung.

When the patient progressed on their first-line therapy, they could receive a targeted therapy that was tailored to what their genomic profile was. This demonstrates the utility of precision medicine in pancreatic cancer—a disease which is no longer one entity, explains Chung. As such, each subtype of pancreatic cancer has a different survival outcome as well as potentially different treatment options.

Dr. Chung on the COMPASS Trial in Pancreatic Cancer

Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, Director Phase I Program, City of Hope, discusses sequencing chemotherapy regimens in patients with metastatic pancreatic cancer.

When it comes to choosing a chemotherapy regimen for patients, much of the decision comes down to toxicity, says Chung. For that reason, Chung recommends starting these patients on gemcitabine and nab-paclitaxel (Abraxane). Although nab-paclitaxel causes a lot of neuropathy, it tends to resolve over time, he adds. If a patient progresses on that regimen, they can start on second-line nanoliposomal irinotecan and 5-fluorouracil, which offers good disease control.

As opposed to nab-paclitaxel, the neuropathy seen with the use of oxaliplatin is more permanent. Therefore, oxaliplatin is typically reserved for later lines of therapy, explains Chung. For a patient with a very good performance status who is given modified FOLFIRINOX, Chung advises dropping the oxaliplatin as neuropathy becomes more evident.

Vincent Chung, MD

Articles

Dr. Chung on Adding Dietary Supplements to Chemotherapy in Pancreatic Cancer

Dr. Chung on the Importance of Genomic Testing in Pancreatic Cancer

Dr. Chung on the Effect of Combo Therapies in Patients With Pancreatic Cancer

Dr. Chung on the COMPASS Trial in Pancreatic Cancer

Dr. Chung on Sequencing Chemotherapy Regimens in Metastatic Pancreatic Cancer