Dr. Kim on PRODIGE 37 in Pancreatic Cancer

George P. Kim, MD, Orange Park Medical Center, discusses the results of the PRODIGE 37 trial in patients with pancreatic cancer.

A recent abstract presented at the 2018 Annual ASCO Meeting looked at alternating sequences of therapy. The randomized phase II trial investigated the use of gemcitabine plus nab-paclitaxel (Abraxane) until progression. The combination was also given sequentially with 5-fluorouracil (5-FU) plus irinotecan for first-line treatment of metastatic pancreatic ductal adenocarcinoma.

The trial showed some improvement in progression-free survival, and an improvement in overall survival of 15.8 months versus 12.4 months, favoring the alternating regimen. However, Kim states that there were toxicities such as increased neutropenia and diarrhea.

Kim also states that he is not fond of using alternating regimens. Rather, he believes in using one regimen for as long as possible, taking into accounting tolerability and efficacy. First-line gemcitabine and nab-paclitaxel followed by a second-line 5-FU—based regimen, as recommended by the NCCN guidelines, is his preferred approach.