Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 3Clinical decision-making in the first-line metastatic setting
1:34 minutes.
TRANSCRIPTION:
DR BEKAII-SAAB: There is real-world data from the US Oncology network. They essentially presented, now twice, and hopefully will publish that data. Just from the databases, when they looked at the usage of gemcitabine/nab paclitaxel versus FOLFIRINOX and they looked at the overall survival, they’re actually very similar regardless of what you start with, which essentially, in my mind, emphasizes the importance of actually rethinking how we treat patients with metastatic pancreas cancer. And rather than do what I call an “all kitchen sink” approach, which is the FOLFIRINOX, it’s think now first line/second line, which is a less toxic approach. Nonetheless, I do believe that it’s likely, at least in the real-world setting, likely will give you about the same survival outcome at the end with less toxicities. In fact, you can argue that, with that approach — that’s the approach with gemcitabine based and a fluoropyrimidine based — then you create a third-line option. With FOLFIRINOX, you have difficulties figuring out what you want to do in the second line. Lo and behold, there are no third-line settings, again, in the absence of clinical trials, which would take precedence. DR GLYNN: What about the combination of oxaliplatin and irinotecan, with just a doublet? DR BEKAII-SAAB: “IROX”? That has not been looked at extensively in pancreas cancer. In colon cancer it was no superior than, say, FOLFOX. So the fluoropyrimidine seems to be an important component of, essentially, the regimen. |