How would you treat a patient with borderline resectable pancreatic cancer with CT showing no change in tumor size after 4 cycles of neoadjuvant FOLFIRINOX?
Would you consider switching to a different regimen?
Answer from: Medical Oncologist at Academic Institution
This is a great question. We have an in-house protocol that is trying to answer this exact question with built-in, arbitrary parameters for clinical, biochemical, and radiographic response to ascertain whether or not to switch to a non-cross resistant chemotherapy regimen after 2 months of neoadjuva...
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Answer from: Medical Oncologist at Community Practice
Most of the data in chemotherapy efficacy in Pancreatic Ductal Adenocarcinoma (PDAC) is in the metastatic setting. PRODIGE 4/ACCORD11 (Conroy et al., PMID 21561347) and MPACT (Von Hoff et al., PMID 24131140) phase III trials established 2 new standard-of-care in the first line treatment of PDAC. Rec...
Answer from: Radiation Oncologist at Community Practice
To build upon the very thoughtful comments of both @Mehmet Sitki Copur and @Ben George - it is not all that uncommon to see relatively stable primary tumor size on interval CT imaging for PDAC. Some of this is post-treatment fibrotic change which is challenging to differentiate from active tumor- pr...
Answer from: Medical Oncologist at Academic Institution
Great question in a challenging subset of patients with a disease process with very poor outcomes. If no radiographic response and CA19-9 response, we would switch to Gem/Abraxane. To maximize the chance of a cure, we need both surgery and chemotherapy. COMPASS showed low expressions of GATA6 were p...