Would you offer surgery for an MSI-H pancreatic adenocarcinoma who had deep response to pembrolizumab?

This is a hard question. The 19-9 gives me pause (even with normalization) and I think most likely I would push on with checkpoint inhibitor therapy for a total of two years given that it is very unlikely surgery will clear disease and ICI may get you to a durable complete response on its own. I don’t think it’s wrong to ask for a formal surgical opinion but I don’t think I would push. I would certainly get a high-quality liver MRI to really assess for number and location of mets prior to embark...

I agree with Dr. LoConte. The patient has 2 scenarios: 1) Has obtained a deep and durable response (complete response): In this scenario, the addition of surgery is potentially only adding surgical and post-surgical complications. 2) Does not have complete response: The chances are that the disease is still active elsewhere, and still, the surgery might not provide cure. Notably, per anecdotal experience, these patients can do well on second-line Nivolumab/Ipilimumab if progression happens, and ...