Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 21Clinical pros and cons of neoadjuvant therapy for patients with resectable pancreatic cancer
2:44 minutes.
TRANSCRIPTION:
DR TEMPERO: Generally, the concept with neoadjuvant therapy is to put the patient in a better position to have a resection with a negative margin. And that’s pretty much in any oncologic setting is the goal of neoadjuvant therapy. You could imagine that there’s also other things that happen during that period of time even if the therapy’s ineffective. You’ve given the patient a biologic waiting period. And in this disease, sometimes it can be a very short time between presentation with what appears to be localized disease and the demonstration of metastatic disease. So you’re culling out, if you will, the patient who is most likely to benefit from the resection simply by waiting and, while you’re waiting, giving some therapy to put them at a better advantage. So those are the good things. The bad things are that, for instance, if your neoadjuvant therapy includes radiation, you might actually complicate things for the patient, in which they can’t get optimal therapy later because of, say, additional damage to the bone marrow. And if you don’t use the right neoadjuvant therapy, such as a therapy that focuses mostly on local therapy, without enough systemic therapy you aren’t giving the patient necessarily what they need if they have occult metastatic disease. So you’re kind of in this balancing act, not knowing which of these things you’re tweaking when you give neoadjuvant therapy. DR LOVE: Tony, any thoughts? DR BEKAII-SAAB: Yes. I think, theoretically, it makes much more sense in anything, frankly, prior to surgery, to give neoadjuvant therapy. And this is one disease where I think it would make the most sense. The one problem is, we don’t have studies that support moving — and we’re talking about the clearly resectable, not the borderline or locally advanced, which is a totally different beast, but those clearly resectable tumors — whether to move the adjuvant therapy into the neoadjuvant setting, so prior to surgery. There have been some small studies that the cumulative outcome of those studies suggests that you don’t do any differently than if you give them in the adjuvant setting. But I think if your surgeons can buy into it, it makes much more sense to bring it forward rather than following surgery. |