Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 36Treatment holidays for patients with metastatic pancreatic cancer
2:49 minutes.
TRANSCRIPTION:
DR TEMPERO: Could I just comment a little bit on something we haven’t talked about, which has to do with treatment holidays? This is a concept that in the US is not very commonly done but in Europe is very commonly done. And with FOLFIRINOX, for instance, after about 6 months of treatment you’ve received your maximum benefit for the most part, but patients have increasing neuropathy, fatigue, other things that suggest that you need to do something different. So everybody does something. They may drop the oxaliplatin. They may trickle along with just the 5-FU and leucovorin, but they keep the patient on some sort of treatment for the most part. At our institution, we have started just giving patients a treatment holiday. We just stop the treatment after 6 months, assuming they have had maximum benefit and no need for ongoing treatment. And those patients have a surprising outcome. Some of those patients can go — I have one patient that it took 4 years before there was progressing disease. DR LOVE: Wow! You observed him for 4 years? DR TEMPERO: Yes, I did. That’s not the only one, either. DR BEKAII-SAAB: Any BRCA? DR TEMPERO: No. DR BEKAII-SAAB: Interesting. DR LOVE: Tony, have you had that kind of experience? Do you do treatment holidays? DR BEKAII-SAAB: Personally, I like treatment holidays across the board with a good discussion with the patient. There is the bias of colorectal cancer injecting into this and understanding that maintenance therapy may prolong PFS. There’s still the question mark whether it affects outcome, overall survival, across multiple malignancies. And so especially with FOLFIRINOX, this is when patients get really, really tired after 6 months. So what I’ve done, actually, is a gradation. So 3, 4 months of FOLFIRINOX, whenever I use FOLFIRINOX in this setting, 2 to 4 months of FOLFIRI/5-FU and then it’s almost like weaning them off and testing the biology as I shave off one drug after the other. Again, this is not a scientific way to do it. This is just a personal way. So oxaliplatin is the one that has the most cumulative toxicity, so it’s the one that goes first. In fact, it has the least amount of data right now in pancreas cancer. Irinotecan stays a little longer than 5-FU, then discuss with the patient the potential for a holiday. And I do think that probably patients progress a little bit earlier than they would otherwise. And I agree with Margaret. I don’t think ultimately we’re changing outcomes by keeping the patients continuously on treatment all the time without any break. DR LOVE: See, I’d be surprised to get beyond a year. I mean, 4 years is really amazing. Have you had patients be observed for more than a year? DR BEKAII-SAAB: Without treatment, maybe a couple. Not many. |