Dr O’Reilly on the Rapidly Evolving Role of Local Therapy in Metastatic Pancreatic Cancer

"[There is] a lot more to come [with local therapy], especially as therapies get better in pancreas cancer, and I can see this being an area that's going to be increasingly developed."

Eileen M. O’Reilly, MD, the Winthrop Rockefeller Endowed Chair of Medical Oncology; chair of the Human Research Protection Program and Institutional Review Board; co-director of Medical Initiatives in the David M. Rubenstein Center for Pancreatic Cancer Research; and section head of Hepatopancreaticobiliary Service at Memorial Sloan Kettering Cancer Center, discussed the evolving role of local therapy in the management of metastatic pancreatic cancer, with a focus on patterns of disease progression and the potential for integrating locoregional approaches in select patient populations.

According to O’Reilly, some patients with metastatic pancreatic cancer—particularly those who develop isolated lung metastases—can experience a more indolent disease course, prompting a role for local therapies. However, in more common clinical scenarios, such as patients with liver metastases, the role of local therapy needs further refinement, O’Reilly said. She highlighted the biological distinction between patients with synchronous liver metastases, which present at initial diagnosis, and metachronous metastases, which arise after initial treatment. She noted that although local therapy is generally not recommended in the setting of synchronous liver metastases due to limited supporting evidence, retrospective data suggest a potential role for local interventions, such as ablation or resection, in patients with metachronous disease. However, she cautioned that these data should be interpreted with caution given their non-prospective nature.

Several prospective trials are now investigating the impact of local therapies in patients with metastatic pancreatic cancer, she continued. O’Reilly referenced the phase 2 EXTEND trial (NCT03599765) conducted by The University of Texas MD Anderson Cancer Center, which was a small, prospective, randomized study that evaluated the addition of radiation therapy to metastatic lesions in patients with oligometastatic pancreatic cancer. The study demonstrated a progression-free survival advantage, though no statistically significant improvement in overall survival was observed, she said.

As systemic therapies continue to improve, the consideration of local therapy in select patients with advanced pancreatic cancer may become more relevant, O’Reilly concluded.