In a patient with borderline resectable pancreatic adenocarcinoma who received neoadjuvant FOLFIRINOX followed by resection that demonstrated residual disease, how do you proceed in the adjuvant setting?
The patient had minimal to no response to neoadjuvant therapy.
Answer from: Medical Oncologist at Academic Institution
In order to answer this question completely, I would need to know more about the neoadjuvant FOLFIRINOX that was given. In a patient who received a full 6 months of neoadjuvant therapy followed by successful surgical resection (albeit with poor response), I would not recommend continuing syste...
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Answer from: Medical Oncologist at Community Practice
I agree with the above answer. At this time, there is no evidence that a switch in therapy is going to result in an improvement in outcome, especially if the patient received a total of six months of neoadjuvant FOLFIRINOX. If less than six months of neoadjuvant therapy was received, a s...
Answer from: Medical Oncologist at Academic Institution
We have debated this among our disease group. In general we have discounted the pathologic determination of response, and continued with adjuvant FOLFIRINOX despite the discouraging pathologic findings. Could the tumor be relatively radiorefractory and had a response to upfront chemotherapy th...
Medical Oncologist
If there was no evidence of response to neoadjuvant chemotherapy would not utilize same regimen in the adjuvant setting. However, based on CT scan sometimes there is response based on 19-9 without radiologic improvement in CT because of fibrosis. Sometimes PET will demonstrate response without CT re...