Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 2369-year-old-man with borderline-resectable pancreatic adenocarcinoma is enrolled on a clinical trial with neoadjuvant PEGPH20, gemcitabine and nab paclitaxel
2:56 minutes.
TRANSCRIPTION:
DR TEMPERO: This is a gentleman who happened to be a very well-known internist in San Francisco. And ironically, I was already caring for two of his patients. But he presented with what he was told was an unresectable pancreatic adenocarcinoma. He came to me thinking that he would probably opt for hospice. He was not interested in chemotherapy, but he wanted to hear more. So we did our usual multidisciplinary review. And our surgeons said, “He appears to be borderline resectable.” DR LOVE: I mean, could they show you the scan and say why? DR TEMPERO: Yes. DR LOVE: What did they see, or what did you see? DR TEMPERO: This had to do with, like, about just close to 180-degree abutment of the SMA. So we had a clinical trial for this, which is good. In this case, it involved a drug called PEGPH20, which is pegylated hyaluronidase. And one of the features of pancreatic adenocarcinoma is this intense desmoplastic stroma. And hyaluronan is one of the elements in that stroma. And PEGPH20 has been shown, at least in preclinical models, to decrease the interstitial pressure within the tumor and allow for better distribution of drug and better concentrations of drug within the tumor. So he went on that trial. It was a single-arm trial, so it’s a signal-seeking trial, with gemcitabine and nab paclitaxel. DR LOVE: I seem to remember some data presented at ASCO. Was it last year on this agent? DR TEMPERO: In metastatic disease, there has been data that suggests that in patients who have high levels of hyaluronan in their tumor that they may be more likely to benefit. DR LOVE: Now, this is single agent or combined with chemo in metastatic disease? DR TEMPERO: With chemotherapy. And by itself, it’s not expected to be therapeutic. It only allows for better exposure to drug. DR LOVE: So this study is trying to bring it into the neoadjuvant setting. DR TEMPERO: Into the neoadjuvant setting, where we would have the opportunity to have preoperative and postoperative tissue, so that we could understand better about what’s actually happening in the tumor milieu. So he was treated. He did very, very well. He had a deep response both radiographically and with CA 19-9. He still required a vascular reconstruction, but he’s doing well now, postoperatively. He’s traveling, just came back from a trip to Europe and is planning another. DR LOVE: What’s his state of mind? DR TEMPERO: He’s very optimistic right now. He’s a cyclist and a hiker. And he’s doing his part by staying active to keep his disease at bay. |