Striving for Consensus: The Application of Existing and Emerging Research Findings to the Practical Management of Gastrointestinal CancersFirst-line treatment of metastatic pancreatic cancer — FOLFIRINOX or gemcitabine/nab paclitaxel
3:18 minutes.
TRANSCRIPTION:
DR GOLDBERG: We are giving FOLFIRINOX commonly to people that are able to take it. We’ve modified the dosing a little bit. So we don’t give bolus 5-FU, and we actually reduce the dose of irinotecan a little bit. But I’ve been giving it to people with reasonable performance scores who opt for the more aggressive therapy. And I’m seeing good responses. One of the cases I sent to you is a case of a 40-year-old woman with SMA-encasing disease but no metastatic disease. It was treated with it and was able to undergo a Whipple. And CA19-9 went from 200 to normal, and back pain disappeared. And so all of us have been looking for the Holy Grail, the treatment regimen that will get our patients with locally advanced, unresectable disease to resection. And this may not be the Holy Grail, but at least it’s a step forward. DR LOVE: I’m going to go back to Eileen and ask you for some more data. And, of course, the big story that occurred this year related to nab paclitaxel. Can you talk about what was presented and also this new Phase II neoadjuvant study? DR O'REILLY: Yes. So we now have another option on the table for treating patients with newly diagnosed pancreatic cancer. And the MPACT study was presented at GI ASCO earlier this year and then the data updated at the main ASCO meeting. So this looked at nab paclitaxel and gemcitabine and compared it to gemcitabine alone, with the primary endpoint being overall survival in patients with metastatic disease. And a couple of points about the study. This was an international study across Europe and North America and included patients from both community and academic centers. And the signal was a positive one. Like with the FOLFIRINOX data, there was consistent improvement in all of the primary and secondary endpoints with regard to tumor response, disease control and overall survival, supporting the use of gemcitabine and nab paclitaxel. DR LOVE: Any way to indirectly compare both efficacy and, importantly, tolerability between these 2 studies and these 2 strategies of FOLFIRINOX and nab/gem? DR O'REILLY: Yes. So I think that’s a big question, and that’s on the table. And we’re all guilty of comparing directly between the studies when we know all of the limitations of that. And certainly, a head-to-head analysis just looking at the primary endpoint would suggest that FOLFIRINOX has the edge, recognizing, of course, that there were different populations. But I would also say that the control arms did equivalently in both studies, so suggesting that it’s not so unreasonable, the comparison, to make. But I think rather than saying one is better, I think it’s options. And it may be that gemcitabine and nab paclitaxel will be an easier backbone to build upon in terms of adding new agents. That’s a whole area that’s beginning to be explored. |