Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 37Perspective on the optimal time to reinitiate therapy for patients on treatment holidays
2:25 minutes.
TRANSCRIPTION:
DR TEMPERO: When patients are being observed and they start to progress, the best idea is to rechallenge them on what they were responding to before, because a significant fraction of them will respond again. And it protects their eligibility for second-line treatment, because they’ve never had another treatment. And this is optimizing their options over time. And you’d like them, if they want to participate in a clinical trial, that second-line setting is so important for that. So it just optimizes their outcome and, I believe, also optimizes their options. DR BEKAII-SAAB: So on that point, I think the most important thing is, whenever I’ve given patients breaks and I’ve observed their tumors, if the tumor starts growing back and the patient’s feeling like a million dollars, I do not restart treatment. Because the way I think about this, this is still a palliative setting, and primarily we focus on the symptoms. And so if the patient doesn’t develop symptoms, boy, the CA 19-9 is going a little bit up and the tumors are growing a little bit. Unless there’s explosion, I mean, multiple tumors showing up and the CA 19-9 going off the roof, you know that it’s just a ticking bomb. But if it’s just a slow progression, concerning, that ultimately we’re going to see that maybe in the next few months, I actually do continue the patient off treatment until they actually start developing some symptoms or I see some accelerated growth. DR LOVE: I’m flashing a little bit on mantle-cell. And what about treatment holidays up front? In other words, observing people from the beginning. Do you do that? DR TEMPERO: The only circumstance I can think of where we do that is in the setting of pulmonary metastases recurring after resection. Pulmonary mets, for whatever reason, very rarely become symptomatic or a cause of death for patients. And so I’m not concerned even when a patient undergoes resection with possible pulmonary mets. You’ll often see this, right, small little indeterminate nodules? It’s okay with me if those are metastatic lesions, because those patients can live for a very long time. Lung-only mets is a very small fraction. It’s even hard to find this in the literature. We have this in the NCCN Guideline text. And you have to really search the article we cite to even find the data to show this, but these patients who have lung-only mets have an extraordinarily long survival. |