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What systemic therapy and dose adjustments would you implement for patients with pancreas cancer and cirrhosis with pancytopenia?
The patient declined palliative measures only and is motivated to receive treatment
Answer from: Medical Oncologist at Community Practice
Of the five drugs available to us, two (abraxane and irirnotecan) are a challenge in liver dysfunction with the added thrombocytopenia. The question becomes, what is the real value of a single drug versus a combination in this setting when it comes down to clinically meaningful efficacy? Capecitabin...
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Answer from: Medical Oncologist at Academic Institution
For cirrhotic patients with enlarged spleens (see your last CT scan) and thrombocytopenia, I treat with full doses if platelets are 50K or higher. This may also be true for patients with prior oxaliplatin high cumulative doses.
There are plenty of platelets available for hemostasis just not i...
Answer from: Medical Oncologist at Community Practice
To Dr. @Hochster's point, we have frequently run into patients with splenomegaly and hypersplenism and we have partnered with our IR group to offer patients partial splenic embolization. We are in the process of updating our prior experience which is available at: Lawson et al., Annals of Pancreatic...
Answer from: Medical Oncologist at Community Practice
Although studies to demonstrate a clear benefit to supportive agents for thrombocytopenia are lacking, we have used Romiplostim, G-CSF, and blood transfusions as necessary in certain situations such as this to support patient counts. Gemcitabine and Capecitabine might be a reasonable regimen to cons...