Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 20Outcomes with neoadjuvant therapy for patients with resectable pancreatic cancer
3:09 minutes.
TRANSCRIPTION:
DR LOVE: What about this issue, Margaret, of neoadjuvant therapy in clearly resectable disease and these data that you refer to? DR TEMPERO: This is early data with 2 regimens that were piloted at MD Anderson. And the reason I thought they were important is, they gave us a real-world experience in terms of what actually happens. So we all see the patient that comes into our clinic who’s got clearly resectable disease. And if you treat them with just chemoradiation, for instance, you’ll be able to give all of that therapy, but only 73 of 86 patients will look like they’re resectable at the time that you get around to completing your treatment. And only 64 will actually be resected. So that just shows you the fallout with the progression of disease that occurs in those intervals as you wait. DR LOVE: So that’s kind of the biologic test you were talking about. DR TEMPERO: In a way. I mean, this is not completely inactive therapy, but it didn’t have a lot of systemic chemotherapy involved in that particular regimen. If you give systemic chemotherapy — now, albeit not what we would consider the most effective systemic chemotherapy — followed by chemoradiation, first of all, you give all the patients the chemotherapy, but only 79 of 90 patients were eligible for the chemoradiation, again because they progressed during that period. So, obviously, they weren’t also able to have a laparotomy. So you keep having this drop-off. And it turns out, about 25% of patients will fall out just during the preoperative treatment period. DR LOVE: What about the survival data? DR TEMPERO: So when I dissected these 2 papers even further, one thing that really struck me was that in the first regimen, the article by Evans, patients who were not resected had a median survival of 7.1 months. On the other hand, patients who were resected, the median survivals were 35 months. DR LOVE: So just for practical purposes, Tony, are there situations right now where you’re using neoadjuvant therapy in patients who are presenting with what appears to be clearly resectable disease? DR BEKAII-SAAB: No, not really outside of a clinical trial. Occasionally, I’d say very occasionally, patients who are borderline in terms of performance status, some comorbidities, like, say, a recent MI or what have you, that the surgeon decided, “I’m going to hold off surgery for a little while, see if you can take them on cruise control.” But other than that, frankly, we have not established this as routine. |