Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 26Perspective on extending the duration of neoadjuvant chemotherapy to achieve resectability
1:57 minutes.
TRANSCRIPTION:
DR SCHWARTZ: I guess what comes up occasionally is, is there really a set number of cycles before you say you’re failing? Because sometimes we have patients that are clearly responding but they’re still not resectable, so can you go an additional few cycles and, potentially, if you’re not going to get them there after 4 cycles, you’re not going to get them there? DR TEMPERO: I think generally, 4 cycles is enough. But there are times when we have continued shrinkage, maybe continued decline in CA 19-9, and we’ll push for another couple of cycles. But generally, 4 is sufficient. So basically it’s a decision about sitting down with the surgeons and deciding when to go ahead. It’s important to remember that for many patients, the post-treatment CT scans don’t look a whole lot different than the pretreatment CT scans, and yet you’ve had a dramatic decline in CA 19-9 and the patient feels great. So you’ve got some other parameters to say, “Yes, we did something.” And so it comes down to an intraoperative decision about whether that tumor can truly be resected. The advantage, I think, of referring your patients, though, to a center of excellence for pancreatic surgery cannot be underscored enough. This is really tough surgery, and you have to be prepared to do a vascular reconstruction. So you need a vascular team that’s very, very skilled right there and on call and ready to come in if that’s what needs to happen. And so I think the studies have been very clear on this in terms of the outcomes with centers of excellence for pancreatic surgery, and I really think that’s important. |